Transplanting smokers' lungs

Although lung transplant patients who receive the lungs of smokers tend to survive for a shorter duration than patients who receive the lungs of non-smokers, researchers in the UK have found that they have a better overall chance of survival than those who remain on waiting lists. The study is published Online First in The Lancet. In recent years media reports have highlighted how some lung transfer patients have died after receiving smokers' lungs, therefore results from this study may prove controversial. Professor Robert Bonser, of the Queen Elizabeth Hospital, Birmingham and University of Birmingham, UK, explained: "Our data show that patients awaiting lung transplantation in the UK are likely to survive longer is they are willing to accept lungs from any suitable donor, irrespective of smoking history - donors with a positive smoking history provide nearly 40% of the lungs available for transplantation. Rejection of this donor-organ resource would increase waiting-list mortality and is ill-advised." According to the researchers, results of this study indicate that the UK's current selection policy of using organs from both non-smoking and smoking donors should be continued. Data from the UK Transplant Registry and Office of National Statistics was used in order to analyze the survival rates of 2,181 adults patients in the UK awaiting lung transplants between 1999 and 2010. Approximately 2 out of 5 of the 1,295 lung transplants that took place during this period came from donors with a history of smoking. The researchers found that patients who received lungs from smokers were 46% more likely to have died 3 years after the procedure than patients who received lungs from non-smokers. However, patients who received lungs from smokers were 21% less likely to die than those who remained on the waiting list during the study period. In addition, the researchers found that when smokers lungs are included in the donor pool, patients with septic lung disease were 40% more likely to survive and fibrosis patients were 61% more likely to survive. The researchers explained: "Although lungs from such donors are associated with worse outcomes, the individual probability of survival is greater is 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. This situation should be fully explained to and discussed with patients who are accepted for lung transplantation." They conclude: "This study establishes that, although donor smoking history adversely affects recipients survival, not to use such donors would increase overall mortality by compromising patients' survival from waiting-list entry." In an associated comment, Dr Shaf Keshavjee and Dr Marcelo Cypel of the Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada, state: "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." In the UK, over 80% of the lungs from brain death and cardiac death multiorgan donors are rejected for transplantation. According to Keshavjee and Cypel, further research is required in order to develop techniques to repair damaged lungs that could be used to increase the amount of lungs available for transplantation.