Woman Dies After Receiving Smoker's Lungs in Transplant
Jennifer Wederell, a 27-year-old British woman with cystic fibrosis, died of lung cancer after she received the lungs of a heavy smoker in an organ transplant.
According to BBC News, Wederell had been on the waiting list for a lung transplant for 18 months when in April 2011, she was told there was finally a match. She received the transplant, apparently not knowing the donor had been a smoker. In February 2012 a malignant mass was found in her lungs. She died less than 16 months after the transplant.
Her father, Colin Grannell, said he believed his daughter had died a death meant for someone else. "The shock immediately turned to anger insofar as all the risks were explained in the hour before her transplant," he told the BBC, "and not once was the fact smoker's lungs would be used mentioned."
Wederell's case raises difficult issues regarding organ transplants. She was diagnosed with cystic fibrosis, a progressive and debilitating lung disease that affects more than 70,000 people worldwide, at the age of two. By her mid-20s, she relied on an oxygen tank 24 hours a day to survive.
Would she have been better off refusing the transplant, and hoping another set of organs became available that matched her blood type and came from a non-smoker?
"Probably not," said Dr. G. Alexander Patterson, surgical director of lung transplants at the Washington University and Barnes-Jewish transplant center in St. Louis, one of the largest organ transplant programs in the nation. "If she was critically ill and had poor chance of short-term survival, she was better off accepting the transplant."
Patterson said most hospitals, including those in the U.S., also transplant the lungs of smokers if they are of otherwise good quality.
"This is a necessity because there are far fewer donors than there are recipients and most patients who are on a waiting list would gladly accept a set of smoker's lungs in exchange for the ones they have, which usually have little chance of carrying them through to long-term survival."
Patterson said that his program would be likely to turn down an organ from a donor if smoking history was too extreme -- say, three packs a day for twenty years -- or if the donor had been known to engage in other risky lifestyle behaviors such as unprotected sex with multiple partners or intravenous drug use. Even those organs might still be used as part of an "extended criteria" donation, which utilizes organs that don't meet the usual criteria for transplant, but are still healthy enough for a successful procedure if a patient needs it quickly.
About 17,000 Americans receive a transplant each year, and more than 4,600 die waiting for one, according to United Network for Organ Sharing, the organization charged with allocating the nation's organs. If surgeons do not accept less-than-perfect organs, Patterson said that the numbers might be much worse.
Don't Ask, Don't Tell
Harefield Hospital in London, where Wederell was treated, has since apologized to her family for not revealing all the information about her donor's medical history. But Patterson said most transplant surgeons don't share details about the smoking history of the donor with their patients unless they are asked directly.
Arthur Caplan, director of the division of medical ethics at NYU Langone Medical Center in New York City said he believed this was a mistake.
"They absolutely should have told her. When you have reasons to think a donor organ is suboptimal in some way, you must disclose it and allow a person to make their own decision. People have to know the risks they face," Caplan said.
Caplin said he thought surgeons might not review such risks in order to avoid having a difficult conversation -- and they may sometimes also feel they are the experts who know what is best for the patient.
"They should do it anyway. Reasonable people can deal with major sources of risk and are exceedingly unlikely to say no to a donation anyway because waiting lists are long and they know they might not get another donation in time," he said.
Patterson said that he understood why Wederell's family was upset, but that it's impossible to know why she developed cancer. Lung transplant recipients receive a great deal more immunosuppressant therapy than other organ recipients to stop the body from rejecting the organ. This may have encouraged the cancer to grow.
"It's plausible that she would have succumbed to some type of cancer no matter what, but there's no way to know for sure," Patterson said.