Everyday Ethics

Everyday Ethics

Should Smokers’ Lungs Be Used?

I recently had an interesting debate about health care with my brother, a doctor in the Navy. As debates between the two of us generally go, we circled around a number of topics before ending the call. One such topic ended with the shared opinion (a shared opinion is mighty rare when it comes to we two siblings) that we wished more people accepted, medically, that sometimes bad things just happened.

I thought of this conversation when reading this story about a soldier who died after receiving a transplant of cancerous lungs — the lungs of a heavy smoker.

Initially, I assumed the sad story was a tragic mix-up, a mistake. And as I said before, perhaps a case in which a bad thing just happened. However, as you read further into the story you see the hospital defends its’ use of smokers’ organs in transplants.

Their defense is that, if smokers were excluded from the donation process, the number of available organs would drop dramatically. Personally, every Brit I know is a smoker, so I can only assume this is true.

Still, is the risk worth it? I’m sure the many saved by a smoker’s organs would say yes. Plus, according to the hospital, this was a very rare case. So did the hospital act unethically? My inclination is to say yes, they did. Legitimate defense or no, surely a *very* heavy smoker should have been excluded from donating his organs — this was a man who apparently smoked up to 50 cigarettes a day!

What do you think? Should this be an accepted practice?
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posted October 13, 2009 at 6:03 pm

Shouldn’t that decision be made by the patient?

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posted October 13, 2009 at 6:30 pm

Marian: You would think, wouldn’t you? I am not well-versed in organ transplant regulations (will do more research tonight) but I would have thought there would be some type of option offered a patient, whether or not to accept a possibly damaged organ.

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An Idle Dad

posted October 14, 2009 at 1:02 am

When there are two people in the room, one layman and one highly trained medical specialist the answer is never “Ask the layman”. This isn’t an ethical question it is a purely medical one.
The doctor should ask for the patients approval for ethical dilemmas, such as offering medical solutions based on pig research (or a pig’s heart) to a Jewish patient. Do you want to proceed based on your ethical beliefs – yes/no.
In the case of lungs from a smoking donor (or any donor for that matter) should be assessed for cancer risk and if possible, checked that cancer does not already exist in the organ.
Passing the buck to a patient – we have a smoker’s lung, sign here or die at the bottom of the list – is a form of legal trickery, not ethics. It is almost the definition of unethical!

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posted October 14, 2009 at 10:42 pm

I’m not an MD, but arguably I am a highly trained specialist in medical-legal issues, so I’m not exactly a layperson either. And the principle of patient autonomy is increasingly embedded in medical ethics these days. If donated organs were more plentiful, then medical professionals could afford to weed out the less acceptable ones before even broaching the subject to the patient. But in the US these days, most patients in need of donated lungs have a choice between whatever is available before the patient drops dead, and nothing at all. Sure, the patient should be the one to decide which of those options to take, and sure, the doctor should inform the patient of any downsides of a particular donated organ. But, however bad the choices may be, they belong to the patient, if the patient is a competent adult.

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An Idle Dad

posted October 14, 2009 at 11:49 pm

With respect, you are confusing ethics with the need for medical professionals in the US to cover themselves from lawsuits. Just because a practice is accepted or even practical does not mean it is ethical. Calling it ‘patient autonomy’ is just spin to make Doctors feel better about protecting themselves from lawsuits. It sounds empowering, but it isn’t really.
That’s because I’d argue that a terminal patient is not a competent adult when it comes to medical decisions. The patient has limited access to detailed facts and neither the training nor time to study them and come to a decision. In your own words you describe the choice as “take it or drop dead”. This is hardly an ethical proposition. It is a decision made under duress. A confession made with a gun to the head is not eligible in court. What matters in court is due process.
The viability of the lung can only be competently determined by the medical expert. If it is not viable, it should not offered to the patient. The question becomes ‘what is viable’ – a separate debate.
Simply grabbing a smoker’s cancer-ridden lung and inserting it into a patient is a medical version of “Sophie’s Choice”. Your suggestion of, in essence, ‘blame the patient as they accepted the lung’ is at best, a questionable legal option, in no way is it an ethical one.
That said, I don’t believe we differ too much in our answers just in the solution: to answer your questions: Should smokers lungs be used in transplants? Sometimes, probably most of the time. Did the hospital act unethically? Only if they did not assess the lung for viability prior to transplant, not because they didn’t use patient autonomy as cover.

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