A slightly controversial and ironic issue hits the Lancet today, with research showing that patients receiving lung transplants from smokers who have died, in general, do better than those waiting for lungs donations from non-smokers.

Lead author Professor Robert Bonser, of the Queen Elizabeth Hospital, Birmingham and University of Birmingham, UK confirmed the announcement:

“Our data show that patients awaiting lung transplantation in the UK are likely to survive longer if 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.”

It seems, overall, that smokers lungs are better than no lungs at all, but there are reports of patients having died after receiving smokers lungs. The authors do acknowledge this problem and clearly the survival rate of a patient accepting a smokers lungs may be reduced, but the UK’s policy of accepting both smoking and non smoking donors increases the pool of available organs and should be continued, as bad as it might sound on face value.

The information from the report was compiled from the UK Transplant Registry and Office of National Statistics. Researchers looked at the survival rates of more than 2000 adult UK patients awaiting lung transplants between July 1, 1999 and Dec 31, 2010. 1295 lung transplants took place during this period, and around 2 in 5 came from donors with a history of smoking.

Those receiving lungs from smokers were 46% more likely to die three years after the transplant than those receiving non-smokers lungs, however, those who took smokers lungs over waiting for non smokers lungs were 21% less likely to die and furthermore the survival rate for patients suffering from septic lung disease and fibrosis rose to 40% and 61% respectively.

While the information is certainly useful, the authors point out the draw backs for patients accepting smokers lungs, and the necessity for doctors to discuss the issues with their patients and the authors conclude that :

“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.”

Dr Shaf Keshavjee and Dr Marcelo Cypel of the Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada add that the risk, reward of accepting lungs from smokers, can vary dramatically from centre to centre, and it’s worth noting that 80% of lungs from brain death and cardiac death multi-organ donors are declined for transplantation.

Written by Rupert Shepherd