Tuesday, 18 December 2012

Smoker's Lungs

A tragic story in the news today concerning a 27-year-old cystic fibrosis sufferer who died of lung cancer after being given a transplant from a smoker.

In this case, the family of the deceased are angry that she was not warned that these lungs came from a smoker and of the consequent risks. The Royal Brompton and Harefield NHS Foundation Trust seem to acknowledge this and apologise for not giving her the choice of whether to take these lungs or wait for a match with a non-smoker, though they do note that almost everyone given such a choice opts to take the first healthy match available rather than wait (the woman in question had already been waiting 18 months).

This, of course, raises issues regarding informed consent. It is a dogma of medical ethics that medical professionals should not do anything potentially harmful to patients without their informed consent. What it is for consent to count as 'informed' is a thorny issue, but it is clear that risks - such as those imposed here - should be explained to the patient, before the patient consents to proceed (or refuses).

Obviously the use of 'marginal' organs is less than ideal. Everyone, given the choice, would prefer young and healthy organs. However, according to statistics given in the BBC article, 40% of lung transplants involve lungs taken from a smoker. If all of these were routinely rejected as unsuitable, there would be fewer lungs available for transplant, resulting in longer waiting lists and more people dying on them.

One of the aims of my work on organ policy is to see how donation can be encouraged, in order to combat what I take to be a pressing moral problem. Increasing the supply of healthy lungs (and other organs) available for transplant could save lives. The policy challenge is to find measures that will be both effective and ethically sound. The aim of the workshops I'm organising next year is to explore some of the possibilities.

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