The Texas Supreme Court sided with the biological parents of a critically ill infant born to a surrogate, rejecting the surrogate's bid to keep the child in a Dallas hospital and clearing the way for an ICU-to-ICU transfer to Los Angeles.

The court ruled Thursday that "sustaining the life of the medically fragile child is the paramount concern in this time-sensitive matter," citing uncontested medical testimony that moving the baby, a boy named Rumi, born August 12 with a severe heart defect, to a Los Angeles hospital gives him the best chance at survival. The decision marks the third state where surrogate McKenna West, 28, of Alaska has lost a custody fight against biological parents Nausheen Gilkar and Omar Ahmed, a California couple who have prevailed in courts in California, Alaska, and now Texas.

The ruling lands in the middle of one of the most closely watched surrogacy disputes in the country, a case that has drawn in the Trump administration, Texas Attorney General Ken Paxton, and now a pending request before the U.S. Supreme Court. At its center is a one-month-old baby with hypoplastic left heart syndrome, a life-threatening condition diagnosed during a 20th-week anatomy scan, and a surrogate who refused the biological parents' request to abort him.

West refused an abortion, then flew to Texas to fight for custody

The dispute began in April, when the fetus was diagnosed in utero with an underdeveloped heart that prevents normal blood flow. AP News reported that Gilkar and Ahmed asked West to abort at 23 weeks, invoking an anomaly clause in the surrogacy contract. West refused.

She then traveled to Texas, where most abortions are banned, to give birth and seek custody of the child. Rumi was born August 12 in Dallas and has been treated at Children's Hospital in Dallas since. He has already undergone one surgery and will likely need more.

Gilkar told a Dallas court in August that she and Ahmed turned to surrogacy after eight unsuccessful rounds of in vitro fertilization and a hysterectomy. The couple has maintained throughout the legal battle that Rumi is their child and that they, not the surrogate, hold decision-making authority over his medical care.

At an August 25 hearing in Dallas, Gilkar made that point directly. "He's our child," she said, wiping away tears, as the Texas Tribune reported.

Rumi's own doctor recommended the Los Angeles transfer

The Texas Supreme Court leaned heavily on testimony from the August 25 hearing. The baby's physician at Children's Hospital in Dallas told the court he recommends the child's remaining surgeries be performed at a hospital in Los Angeles and that delaying the transfer would create "much more complicated treatment" for Rumi.

Susan Duesler, the guardian ad litem appointed to represent the infant's best interests, filed a brief with the Texas Supreme Court supporting the doctor's recommendation. She said the child should get the care his doctor recommends, which may include the California transfer.

The court's disposition quoted the medical testimony directly: "The limited materials before this Court describe uncontroverted medical testimony of the child's Texas physician indicating that 'the child's best interest in order to preserve the child's life as long as possible [i]s an ICU-to-ICU transfer.'"

Lawyers for Gilkar and Ahmed told the court that the guardian ad litem had testified the parents "'have followed the recommendations of the doctors to a T'" and that doctors had "'unequivocally, no' concerns regarding the Parents medical decision-making." The parents' legal team also insisted that hospice is not part of the child's medical plan, pushing back on suggestions that the couple intended to withdraw care.

The case raises questions that have surfaced in other recent disputes over parental authority and child welfare reaching the nation's highest courts: who decides what happens to a child when the adults involved disagree, and how far can a surrogate's moral convictions override a legal contract?

Paxton and the Trump administration stepped in early

Before the Texas Supreme Court weighed in, the case had already drawn powerful allies to both sides. Texas Attorney General Ken Paxton filed legal action to ensure Rumi received medical care after the biological parents allegedly refused to consent to heart surgery earlier in the dispute.

The Washington Examiner reported that West won an early court victory with Paxton's backing, securing a ruling that the baby must receive life-saving treatment.

"Baby Gabriel deserves a chance at life, and I will not allow anyone to unlawfully deny him medically necessary care."

That was Paxton's statement at the time, as Just The News reported. The attorney general framed the intervention as a defense of every child's right to medical treatment in Texas.

The Trump administration's HHS Office for Civil Rights also intervened, sending letters to Children's Medical Center of Dallas and UT Southwestern Medical Center. The letters outlined federal disability civil rights obligations, warning that federal law "prohibits withholding medical treatment based on a person's disability, including based on judgments that the life of someone with a disability has less value or that the individual would impose a burden on others," Breitbart reported.

That federal intervention put hospitals on notice and helped ensure Rumi's first surgery went forward. But as the legal fight shifted from whether the baby would receive care to who would control his care, and where, the courts consistently sided with the biological parents.

West now wants the U.S. Supreme Court to step in

West has filed an emergency request with the U.S. Supreme Court to intervene. Her lawyers argued that "relief was urgently needed" and that "future care for Baby G. is uncertain and unknowable," warning that the California couple might withhold life-saving surgical care. West's legal team contended she has been "denied any information about or control over the medically fragile child."

Gilkar and Ahmed fired back with a heavily redacted response, arguing the case has already been decided and falls outside the Supreme Court's jurisdiction. They warned that intervention in West's favor would interrupt their child's medical care with "chaos."

Lee Budner, the couple's attorney, issued a pointed statement Friday:

"While McKenna West has been conducting a publicity tour, Rumi's parents have been quietly caring for their child and following the recommendations of Rumi's medical team."

Budner added that "West's requested stay to the United States Supreme Court threatens the continuity of Rumi's medical care" and that a stay "would not change who Rumi's parents are. It would only create confusion over medical decision-making authority and jeopardize the providers' ability to rely on the parents' consent to Rumi's treatment."

West's attorney did not immediately respond to a request for comment. The trial court case has been sealed from public view.

The dispute over who holds authority over a child's welfare, parents, surrogates, or the state, has become a recurring flashpoint in American courts. This case adds a volatile new dimension: what happens when a surrogacy contract collides with a life-or-death medical diagnosis and the surrogate's conscience.

Three states, one answer: the biological parents decide

Courts in California, Alaska, and Texas have now all ruled in favor of Gilkar and Ahmed. A Texas judge found that West does not have custody over the child she birthed in Dallas. California recognized the couple as Rumi's legal parents. Alaska, West's home state, reached the same conclusion.

West's position, that she should have conservatorship to make medical decisions for a baby she carried but is not biologically related to, has found sympathy in public debate but not in any courtroom so far. Her refusal to abort a child diagnosed with a severe heart defect earned her support from pro-life advocates, Paxton's office, and the Trump administration's civil rights enforcers. But the legal system has drawn a consistent line: biological parentage, not the surrogate's moral objections, controls custody.

Whether the U.S. Supreme Court will disturb that consensus remains an open question. The court has not yet acted on West's emergency request. If it declines to intervene, Gilkar and Ahmed will be free to transfer Rumi to Los Angeles for the surgeries his Dallas doctors have recommended.

The broader legal questions around parental rights and court intervention in family decisions are not going away. Surrogacy arrangements are governed by a patchwork of state laws, and cases like Rumi's expose the gaps, what happens when the surrogate's convictions, the parents' legal rights, and a child's medical needs all point in different directions.

McKenna West did something few people would have the courage to do: she refused to end a life when the contract told her to. That took grit. But grit does not revise parentage law, and three state courts have now said so. The only question left is whether nine justices in Washington see a reason to disagree.