Published January 29, 2013
For patients with lung disease in need of a full-lung transplant, time is of the absolute essence – as the average survival rate without surgery is only one to two years, according to the National Heart, Lung, and Blood Institute (NHLBI).
Although transplant patients do not have much time to wait, that is what many of them inevitably wind up doing. A critical shortage of organ donors leaves many of these patients without the vital organ they need, and a large portion of those on the waiting list simply do not get a new pair of lungs in time.
To combat this problem, researchers from Temple University Hospital in Philadelphia decided to think outside the box, in order to come up with ways of expanding the usable field of lung donors. Their research ultimately led them to the least likely candidates of all – heavy smokers.
The new study found that lungs from selectively chosen donors who have had an extensive smoking history, performed just as well in adult, double-lung transplants as lungs from non-smokers. According to Dr. Sharven Taghavi, a surgical specialist at Temple and one of the study’s lead authors, the decision to look at smokers was a result of the desperate need for other avenues for organ recipients.
“The average waiting time for receiving donor lungs is over a year,” Taghavi told FoxNews.com, “and these patients are pretty sick, so most people do not end up getting the lungs they need.”
According to the NHLBI, more than 1,600 patients in need of lung transplants were on the Organ Procurement and Transplantation Network waiting list by the end of2012. Even as that number fluctuates, the NHLBI estimates that only half of those on the list will receive their needed transplant each year.
To find a possible solution to this acute issue, Taghavi and his team analyzed data from United Network for Organ Sharing database, reviewing information from 5,900 double-lung transplant recipients. Of the patients, who had received a transplant between 2005 and 2011, 766 (or 13 percent) had been given lungs originally from heavy smokers. To qualify as a heavy smoker, the donor had to have smoked at least a pack of cigarettes a day for more than 20 years.
When comparing the recipients who had received lungs from heavy smokers and those who had received lungs from non-smokers, the researchers found little difference in patient outcomes.
“The number one thing we looked at was survival, which was similar between the two groups,” Taghavi said. “And an obvious concern is lung function, or how well do these people breathe. We looked at forced expiratory volume – basically a measure of how your lung function is – and we compared that after transplantation. They were not different.”
Even the number of deaths due to malignancy was not different in the two groups of recipients, despite the established link between smoking cigarettes and the development of lung cancer.
Under the current guidelines from the International Society for Heart & Lung Transplantation, using lungs from heavy smoking is generally discouraged and lungs cannot be used unless the donor was free of substance addiction for at least six months prior to surgery.
However, Taghavi noted that certain situations would possibly warrant the use of smokers’ lungs, albeit in very rare occasions.
“You may have a patient who is really sick, and it’s a life or death situation and needs the lungs to survive,” Taghavi said. “That may lead a transplant surgeon to accept lungs of smoking donors. In another situation maybe where the donor is an excellent donor except they’ve smoked for a long time, but if everything else looks great and you have a sick patient, may lead someone to accept the lungs.”
Since only a very small percentage of the donors they examined had an extensive smoking history, Taghavi said their research should ultimately be interpreted with caution and that further research is necessary to determine whether or not smokers’ lungs could be viable options for transplant recipients. But he said that if these findings hold constant in future studies, there are many things doctors can do to ensure the health of organ recipients who receive lungs from heavy smokers.
“What we recommend is careful examination of the lungs for evidence of tumor or cancer,” Taghavi said. “There are several things you can do, such as chest X-rays, CAT scans, or a bronchoscopy. Then finally on procurement, when you’re taking the lungs out, the surgeons do a careful inspection of the lungs.”
While a change to the donor guidelines may be a way off, Taghavi is holding out hope for any way to expand the field of available donors.
“I think it could have a great impact,” he said. “It would increase the number of organs available for transplantation and ultimately decrease the number of people who die waiting for donor lungs.”
The study was released Tuesday at the 49th Annual Meeting of The Society of Thoracic Surgeons held at the Los Angeles Convention Center.