Bad news, good news, bad news

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  • #1
lisab
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Bad news: a young man gets a terrible lung disease.

Good news: he gets a lung transplant.

Bad news: the lungs he gets belonged to a heavy smoker and he dies a year later, of lung cancer.

The critical question here, which I can't find in the article: did the patient know the donor was a heavy smoker before the transplant, and did he have an informed choice? If his only choice was, a) heavy smoker's lungs, or b) take a chance at dying before we get you a non-smoker's lungs....what a decision to have to make! It seems unethical to force the patient to make that choice.

But if that choice was made for him...well that seems unethical too, if the decision is - yes we will give you a compromised organ.

Is it ethical for doctors to use organs from a donor whose lifestyle makes those organs susceptible to a particular disease, if the patient doesn't know?

This seems a Catch-22. It seems unethical to force the patient to make the decision, and it seems unethical to make it for him.

How does medicine deal with this?

http://www.cnn.com/2009/HEALTH/10/12/soldier.lung.cancer.transplant/index.html" [Broken]
 
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  • #2
mgb_phys
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Not all smokers get lung cancer - also a smokers lungs doesn't necessarily mean from a 60 year old who had been smoking 40 a day for 40years. Does ever having smoked disqualify a donor? How many a day ?
Looks like this was a screw up, or the patients history was wrong

Here on the other side of the atlantic they go to the opposite extreme. They won't take my luscious fit young non-smoker body (well 1 out of 4) because I lived in the UK and so am a walking case of mad cow disease. Even more ironically the UK won't take my blood anymore because everyone visiting the USA has West Nile virus.
 
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  • #3
DaveC426913
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Why would a heavy smoker's lungs be up for donation in the first place? Surely that would disqualify them?
 
  • #4
Monique
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Why would a heavy smoker's lungs be up for donation in the first place? Surely that would disqualify them?
I'm surprised as well, but I don't know the actual criteria for donation.

One thing to keep in mind is that an organ transplant patient needs to take life-long immunosuppressant drugs, which gives them a http://www.ncbi.nlm.nih.gov/pubmed/...el.Pubmed_DefaultReportPanel.Pubmed_RVDocSum". I would think that you don't give such patients a lung that has already an increased risk of developing cancer. On the other hand, the increase in the quality of life of the patient and the lack of donors may outweigh the risks of the transplant.

Here is a review, that I unfortunately don't have access to:
http://www.ncbi.nlm.nih.gov/pubmed/...el.Pubmed_DefaultReportPanel.Pubmed_RVDocSum"
With the increase in the number of lung transplants, it is expected that there will be a corresponding increase in the number of lung cancers reported in these patients. Longevity of the transplant recipients, lung transplantation for chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis, a history of smoking, and the increasing age of the lung donors make lung cancer more likely. Nodules and masses seen in chest imaging in lung transplant patients call for work up until a final diagnosis is achieved because there is a high likelihood of a serious infection or malignancy. The presence of a native lung is a major risk factor for lung cancer occurring in the transplant setting. Lung cancer of donor origin is rare. Bronchioloalveolar carcinoma confined to one lung can potentially be treated by transplanting the affected lung. Treatment for patients with lung cancer in the lung transplant setting has to be individualized because of the complexity of their medical problems and multiple medications. Attention needs to be focused on detecting lung cancer early in these patients to achieve a favorable outcome
 
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  • #5
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Basically there is a healthy organ shortage, and you are given a choice to take an organ from someone with known conditions, or not take it.
 
  • #6
DaveC426913
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Basically there is a healthy organ shortage, and you are given a choice to take an organ from someone with known conditions, or not take it.
It's true. I saw it on House. :biggrin:
 
  • #7
fluidistic
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Can the lung cancer caused by the transplanted "ill lung" spread over the whole organism like a generalized cancer? Like a common lung cancer.
If so then transplanting cancerous organs seems dangerous and it is a way of transmitting cancer. I've always been told it's impossible to transmit cancer. I'm glad I've learned something here, unless I'm wrong.
 
  • #8
lisab
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It's true. I saw it on House. :biggrin:
True, forcing a sick patient make this choice really does have a TV drama aspect to it!

I think there should be either some mechanism to exclude organs that have a high likelihood of being unhealthy for the recipient, or the recipient should know at least the basic lifestyle of the donor and have the choice to decline.

But the root cause of this horrible dilemma: there are not enough donors.
 
  • #9
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It's true. I saw it on House. :biggrin:
that's confirmation bias :bugeye:


But the root cause of this horrible dilemma: there are not enough donors.
and that people smoke
 
  • #10
Monique
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Can the lung cancer caused by the transplanted "ill lung" spread over the whole organism like a generalized cancer? Like a common lung cancer.
If so then transplanting cancerous organs seems dangerous and it is a way of transmitting cancer. I've always been told it's impossible to transmit cancer. I'm glad I've learned something here, unless I'm wrong.
Organs that are transplanted are matched so that there is the least likelihood of rejection by the recipient, on top of that the transplant patients are on immunosuppressant drugs so that their body can't fight the foreign tissue. So yes, the tumor can spread.

On a more grim note, although very rare mothers can spread their tumors (leukemia or melanoma) to their unborn baby. There is a recent publication in PNAS where a case is described that mother developed leukemia 1 month after giving birth and the baby developed leukemia 10 months later. Both tumor cells contained the same de novo mutation and are thus likely of the same origin, the tumor evaded the immune system of the baby probably through a 6p deletion (a chromosomal region that harbors the HLA immunorecognition genes).

http://www.pnas.org/content/early/2009/10/09/0904658106.abstract"
 
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  • #11
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Is it all immunosuppresant drugs or just specific ones? I have an auto-immune disease for which I take Tumor necrosis factor binding proteins. Does this increase my risk of cancer?

I realize the name "tumor necrosis factor" might be the answer to my question, but still curious.
 
  • #12
Monique
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Is it all immunosuppresant drugs or just specific ones? I have an auto-immune disease for which I take Tumor necrosis factor binding proteins. Does this increase my risk of cancer?

I realize the name "tumor necrosis factor" might be the answer to my question, but still curious.
That's a good question, but I'm afraid I can't give a clear answer. TNFa is implicated both in tumorigenesis and anti-tumorigenesis, it really depends on the dose. You do want to suppress the inflammation associated with the auto-immune disease, since that in itself can be a factor in tumorigenesis. There are clinical studies being done that study the long-term effect of TNF-inhibitors, the best thing is to talk to your doctor and evaluate your medication and family history and schedule regular check-ups.
 
  • #13
Moonbear
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If the patient died only a year later of lung cancer, it's hard to believe the tumor wasn't already present in the transplanted lung, and I would agree it makes no sense why that organ (or donor) wasn't rejected. The key here isn't that the donor was an occasional smoker, or smoked for a year or two when young and quit, etc., but that the donor was a HEAVY smoker at the time of death.

When considering transplants, I don't think it's enough to just toss any matching organ into a recipient if the prognosis is going to be pretty lousy with that organ. Rejection is already a high enough risk factor, you wouldn't want to complicate matters further with an organ that has a high likelihood of being diseased or developing a disease in a short time.
 

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