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Jennifer Heisler, RN

Patient Dies After Receiving Smoker's Lungs As Transplant, Why Those Who Say Smoker's Lungs Should Not Be Used Are Wrong

By June 15, 2010

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A patient from England died 5 months after her double lung transplant.  Her parents are now saying that she would have declined the transplant if she had known the donor was a 30 year smoker.

It is impossible to know if declining the lungs and waiting for non-smoker's lungs would have saved this patient.  It is quite possible that even pristine lungs from a non-smoker would have ended in the same result.   It is also possible that she could have died waiting for non-smoker's lungs that never became available.  What I do know is that if the recipient was on the transplant list she was very sick, and patients get sicker as they wait, not better.

I can't imagine what this family is going through, but I can say that placing a blanket exclusion on transplanting the lungs of smokers would result in hundreds if not thousands of deaths each year.  You see,  all over the world people (who are not transplant professionals) are saying there should be a ban on transplanting the lungs of smokers.

Yes, people are saying that smoker's lungs should never be transplanted, that only non-smoker lungs are good enough to transplant, and more.  Of course, not a single one of them is a pulmonologist, transplant surgeon, procurement coordinator or a transplant nurse.

As a transplant professional, these comments irk me to absolutely no end.  Why? Putting a blanket exclusion on the lungs of smokers would mean approximately half as many people in America would receive a lung transplant... or put another way, many more would die waiting for a transplant that will never come.

Smoker's lungs are not the devil.  If the donor was a marijuana smoker or a cigarette/pipe smoker it does not mean that the lungs are not transplantable.  Many tests are done to evaluate the viability of every organ that is transplanted.  For lungs, that means many blood tests to check the function, several bronchoscopies, lung recruitment techniques and more.  All of this done to make sure that a life can be saved.

Are smoker's lungs used without a great deal of thought? No.  They must pass the rigorous testing that non-smoker's lungs go through.  Are non-smoker's lungs preferable? Almost certainly.

Here is another way to look at the issue, one that happens more frequently than anyone would like to think.  Imagine you are the family member of a critically ill patient who is waiting for a lung transplant in the ICU.  The doctors have told you that if lungs do not become available in the next 48 hours that your loved one will not make it.  24 hours later, the phone call you've been waiting for.  Lungs are available, but the donor was a smoker.   What would you say?

Sometimes, smoker's lungs are better than no lungs at all. In fact, for thousands, smoker's lungs are better than their very own lungs.

What do you think?

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June 16, 2010 at 9:43 pm
(1) Steve Ferkau says:

Thank you so much, Jennifer, for putting this into context… I keep my eyes open for news stories regarding lung transplant and I’ve been getting dozens and dozens of hits on this in the media and in the blogsphere — and virtually all of the slants from all sources are that giving this girl these lungs was unconscionable… As you pointed out — that’s simply not true…

That this particular donor’s smoking habit may not have been discussed with the family may be true — but I know from experience that many of us are advised that getting lungs from a smoker, even a long term smoker, is a possibility… And often times we may be advised that a donor is “high risk” and given a chance to pass — but as you pointed out, if we’re dying there are not many options…

When I was listed, our surgeon discussed with a group of us that they would accept lungs from someone who has smoked a pack a day for twenty years — the lungs would be more closely examined, but if they were functioning well and we needed them — it’s a resource that may be difficult to turn down… Transplant is always a crap-shoot… There can be so many other complications beyond smoking — but this one seems so easy to see that it’s blathered on by the media.

There was another very sad case revolving around an Iraq war vet from the U.K. who was given smoker’s lungs and developed cancer… And, as you mentioned in this case — Lyndsey died of pneumonia… All of us recently transplanted folks, including other organs besides lungs, are at very high risk for infections and pneumonia…

I so wish Lyndsey had survived, and come to appreciate breathing with “real” lungs instead of cystic fibrosis lungs — it’s truly beyond understanding… After living so long with crappy, cystic fibrosis lungs — and not even truly understanding that you’re struggling, simply because you don’t know any better — then breathing with an incredible gift from a donor and donor family… I wish she could have experienced how good it can get… The sad fact is, smoking or non-smoking donor, 20% of us lung recipients do not survive the first year. I wish Lyndsey would have been one of the survivors…

Thank you again for shedding a little light on this topic. My lungs came from a beautiful 17-year-old girl from Iowa named Kari. I’ve been breathing with her gift for 10 years now, and I think about how this feels constantly — and I think about her constantly too… One other thing that this situation sheds light upon is that there are simply not enough donors in the world — probably between a quarter and half of the people waiting for lungs will die before they are offered lungs… If more people were aware, and agreed to organ donation, maybe fewer would die, and maybe they would have the luxury of turning down an organ deemed questionable. (However, these lungs were likely still not “questionable”…)

Love, Steve

June 17, 2010 at 5:12 pm
(2) surgery says:

Thank you for your comments Steve. I’m so happy that you are doing well and to see you honor your donor makes me smile.

I do think this is an important issue. What I don’t want is for families to refuse to consent to lung donation if their loved one was a smoker. This story has the potential to do more harm than good.

Please feel free to post information about your website in the forum area!

July 2, 2010 at 4:25 pm
(3) CygnusDan says:

I would have to say any lungs would be better than none at all. Thank you for your post. I have never really put much thought into becoming a donor until reading this. Thank you for the inspiration to do something special for someone after I pass.

January 31, 2011 at 9:19 am
(4) Kathleen says:

Having smoker’s lungs myself, I think I’d prefer having them as transplants, even over a nonsmoker’s lungs if that were my choice. I think a nonsmoker should get them instead of me, if this was the situation, and, besides, the thought of me defiling another pink lung is anathema since I can see that I can never stop my habit.

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