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Page last updated at 15:18 GMT, Monday, 14 June 2010 16:18 UK
Should a smoker's lungs be used in organ donation?

Surgeons in operating theatre
A quarter of all transplant operations now use marginal organs

How much should a transplant patient know about where a donated organ has come from?

The question has been raised following the case of Lynsey Scott, a cystic fibrosis sufferer from Wigan who died months after having a double lung transplant at Wythenshawe Hospital.

Allan Scott said it was only after applying for his daughter's medical notes that he discovered that her donor had been a smoker for 30 years.

He wants patients to be told about the donor's history so that they can make an informed choice.

But a hospital spokesman has said that allowing patients to 'pick and choose' donors would result in longer waiting lists and more deaths.


In a perfect world, all organs donated for transplant would come from healthy, non-smoking individuals.

Lynsey Scott
Lynsey Scott from Wigan who died months after a double lung transplant

The reality, of course, is very different: because of a national shortage of donors, many transplants involve the use of so called 'marginal organs.'

Marginal organs are deemed to be of higher risk, but still considered safe, and their use is controlled by national guidelines set out by the NHS Blood and Transplant Service.

Ten years ago, 13% of all transplants used marginal organs; now that figure has increased to more than 25%.

Now, the University Hospital of South Manchester (UHSM) has admitted that Wythenshawe Hospital has extended its criteria to 'increase the number of viable lungs available for donation.'

'Pick and choose'

But should a patient be told everything about that organ and where it's come from?

You could end up with a situation where patients could discriminate on the basis of age or gender or lifestyle and end up back on the waiting list."
Laura Parker, UHSM

UHSM spokesperson Laura Parker said there was a danger that it would result in a 'pick and choose' culture.

"For example, if as a 27-year-old transplant patient I was told that my donor was 55, I might say 'no, I don't want it', when it was perfectly viable," she said.

"You could end up with a situation where patients could discriminate on the basis of age or gender or lifestyle and end up back on the waiting list."

She added that 30% of patients in need of new lungs die waiting for a transplant: that would only get worse if patients started to decline transplants for the wrong reasons.

"What we're saying is trust the doctors," she added.

"If they have deemed these organs are 'excellent', it means they can be used to extend the lives of our patients.

"And yes, that applies to smokers' lungs: if they are still of good quality, we will use them."

Right to know

Professor Nadey Hakim works at Europe's largest kidney treatment centre at Hammersmith Hospital.

Wythenshawe Hospital
The Transplant Centre at Wythenshawe Hospital began heart transplants in 1987 and lung transplants in 1992.
To date, more than 750 transplants have been carried out
The New Start charity has raised over £7.5 million for transplants and the building of the £1.9m Jim Quick Transplant Ward

He believes that a patient does have the right to know exactly where that organ comes from, especially in the case of marginal organs.

"Obviously those lungs are not going to do as well as organs from a healthier donor. It's a bit like having a liver donated from an alcoholic or a kidney or a pancreas from a diabetic.

"But I have to say that I agree with Allan Scott - I personally would be very clear and we have to be very honest and give full details to the patient before they are transplanted so they are happily in full possession of the facts."

Professor James Neuberger is the associate medical director at NHS Blood and Transplant Service.

He said that while recipients need to fully understand the implications of transplantation before they consent, he said there were often difficult decisions for both doctor and patient.

"Often it is just not possible to give all the information to the recipient because all the information won't necessarily always be available until the time that the surgeons have had the opportunity to look at the organ.

"You have to balance the risk of the transplant.... against the risk of not getting a transplant which, for most people is, unfortunately, death."

Organ patient got smoker's lungs
14 Jun 10 |  Manchester

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