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Use of Smokers' Lungs for Transplant Has Pros, Cons
Date:5/29/2012

died three years after transplantation than those who received lungs from non-smokers. However, patients who received smokers' lungs also were 21 percent less likely to die than those who remained on the waiting list.

The researchers also found that including smokers' lungs in the donor pool increased the likelihood of survival by 61 percent for patients with fibrosis and by 40 percent for those with septic lung disease.

"Although lungs from such donors are associated with worse outcomes, the individual probability of survival is greater if they are accepted than if they are declined and the patient chooses to wait for a potential transplant from a donor with a negative smoking history," the authors wrote. "This situation should be fully explained to and discussed with patients who are accepted for lung transplantation."

One expert in the United States said the study "raises a few issues."

Dr. Len Horovitz, pulmonary specialist at Lenox Hill Hospital in New York City, said that "because many patients may die awaiting transplant, one might argue that a lung damaged by smoking (not severely) would be better than no functioning lung at all. But lungs of smokers may be mild or moderately damaged (COPD), and also carry the risk of lung cancer, especially with post operative chronic use of immune suppressors. Nevertheless, in a dying patient, the prolongation of life -- however long that may be -- [and] the benefit is clear."

Although these findings have clear implications for the United Kingdom, it "is important to realize that the relation between risk of dying on the waiting list and the benefit of accepting a transplant from a donor with a substantial smoking history can vary by country and center," Dr. Shaf Keshavjee and Dr. Marcelo Cypel of the Toronto Lung Transplant Program of the University Health Network in Canada, wrote in an accompanying commentary in the journal.

More information

The U.S. National Heart, Lung,
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