Transplant Surgeons Don't Always Tell Patients About Organ Quality

June 16, 2010— -- A U.K. family is outraged after learning that their now-deceased-daughter received a double lung transplant from a long-time smoker. But it's a situation that occurs all over the world, and fairly often, according to transplant surgeons.

In today's scarce organ market, a smoker's lungs are not off limits, transplant surgeons say. In many cases, the donations have been shown to be lifesavers.

A sufferer of cystic fibrosis, Lyndsey Scott, 28, was on the waiting list for a double lung transplant for 20 months before she got the long-awaited call promising new lungs, but neither she nor her family were warned that the donor had been a smoker for 30 years, according to reports in the U.K. press.

There were complications following the surgery, but Scott pulled through, only to die from pneumonia in July of 2009 -- months after the procedure.

Shocked that they weren't told about the donor's smoking habit, Scott's family is now calling for better doctor-patient communication during the transplant procedure, a request that not all transplant surgeons agree with.

"In general there's been a transition in medicine to give patients more autonomy in decision making," says Dr. Michael Volk, an expert in patient-physician communication regarding transplant issues at the University of Michigan. But, he added, transplant doctors are "still relatively paternalistic."

"We really don't tell patients that much about organ quality, partially because it's difficult for them to gauge risk," Volk says.

"Patients are aghast that we would give them anything but the best, but they don't understand what to us as transplant physicians seems obvious: if you offer patients only the best quality of organ, than you wouldn't transplant many organs, and more people would die on the waiting list."

Given the complex factors going into the risk assessment of a donor organ, "patients have no choice but to trust that the team that is transplanting them is selecting organs for them that are felt [to] have a reasonable chance of a good outcome," says Dr. Jeffrey Punch, chief of the division of transplantation at the University of Michigan.