Transplant Surgeons Don't Always Tell Patients About Organ Quality

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.

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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.

Don't Ask, Don't Tell for Transplant Patients

It may seem surprising that a transplant surgeon wouldn't disclose the risks of a potential donor organ with the patient, but surgeons have their reasons, transplant experts say.

Given the growing size of the organ waiting list and the grossly insufficient supply of donor organs, "we are pushing the boundaries with marginal donors," says Dr. David Cronin, associate professor of surgery at the Medical College of Wisconsin.

"We use these organs with the expectation that they will work," he says, noting that when patients are offered the organs, the doctor has already weighed the risks and deemed the organ worthy.

"You can't expect transplants to be risk- and death-free," Cronin says, "but the consequence of not enough organs is certain death."

So why not share all the risk information with patients at the time of their decision to undergo surgery?

"Physicians are afraid that [sharing certain information] will scare patients away -- and that's a real concern," says Volk. "Even if the risk of getting HIV from a liver is very, very small, patients will turn down an organ [that] we believe their survival depends upon. Physicians have to make that call."

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