Earlier this week a BBC News copyrighted article reported that a woman from the U.K. received a double-lung transplant from a donor who had smoked for thirty years. The recipient, Lynsey Scott, suffered from cystic fibrosis underwent the organ transplant to prolong her life when, at the age of 28, her health condition deteriorated. Ms. Scott died a few months following the transplant with the official cause of death determined as pneumonia.
According to the article, Ms. Scott’s father, Allan Scott, believed that his daughter would have rejected the transplant offer if she had known the donor was a smoker. He stated that she would have been “horrified” and “would have refused the operation.” In the U.K. there are guidelines for the use of organs and “marginal” organs can be used for transplant under guidelines provided by the National Blood and Transplant Service. It is believed that physicians followed these guidelines in Ms. Scott’s situation.
This does beg the question of whether this can occur in the U.S. Though the Iowa Donor Network did not immediately respond to this question for this article, it’s website indicates that there were 1,478 lung transplants in 2008 nationally. The web-site’s media kit identifies “Three Principles for Public Trust in Donation” including: ongoing oversight, informed consent, and informed decision-making. In following these principles one could reasonably presume that a lung donor’s medical history would indicate her/his history of smoking. Reason would also follow that the recipient should have a say in whether an lung from a smoker should be placed in their body. Such agreement was apparently not obtained in the U.K. case and the Iowa Donor Network website does not appear to indicate whether a patient can obtain a donor’s history that might influence the recipient’s own health outcome. The website does indicate that the transplant surgeon must accept the organ for transplant.
Though it is unreasonable to draw comparison between practices in the U.S. and the U.K. associated with this article it raises questions of whether organ recipients should be fully informed about the organs they receive. Under the bio-ethical principle of autonomy, it is reasonable think that the patient should have some level of authority to decide if a donor’s organ is too great a risk for transplant yet the physician ultimately must determine the health and safety of a donated organ. There are no perfect organs, as the BBC article points out, but who should have the final say for the patient when it’s the patient’s life that hangs in the balance? The best scenario would appear to be a discussion between the physician and patient that discloses the issues with the imperfect organ so that a joint decision could be made.