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About 13 percent of double-lung transplants in the U.S. came from donors who were heavy smokers, a new study finds.

Using lung transplants from heavy smokers may sound like a cruel joke, but a new study finds that organs taken from people who puffed a pack a day for more than 20 years are likely safe.

What’s more, the analysis of lung transplant data from the U.S. between 2005 and 2011 confirms what transplant experts say they already know: For some patients on a crowded organ waiting list, lungs from smokers are better than none.

“I think people are grateful just to have a shot at getting lungs,” said Dr. Sharven Taghavi, a cardiovascular surgical resident at Temple University Hospital in Philadelphia, who led the new study.

Surprisingly, however, organ recipients who do get smokers’ lungs often learn about it only afterward -- if at all, experts say.

“If someone had a transplant and after the transplant they say, ‘What can you tell me about the donor?' there are a limited number of characteristics we can tell them,” said Dr. Ramsey Hachem, a pulmonologist at Barnes-Jewish Hospital in St. Louis. “We don’t do that routinely before.”

About 13 percent of double-lung transplants in the U.S. came from donors with a heavy smoking history, according to Taghavi’s new study, presented Tuesday at the annual meeting of the Society of Thoracic Surgeons. He and his colleagues analyzed records of some 5,900 adult procedures in the database maintained by the United Network for Organ Sharing, or UNOS, which manages transplants in the U.S.

Typically, that meant smoking at least a pack of cigarettes a day for more than 20 years, or two packs a day for 10 years.

In the end, after all other variables were accounted for, people who got lungs from heavy smokers lived as long and as well as those who got lungs from the tobacco-free, Taghavi found. There was no significant difference in cancers, though the study didn’t specifically look at lung cancer.

“General guidelines say that donors that have smoked should be excluded, but there are certain circumstances in which they can be used,” Taghavi said. “That can be when the donors are otherwise very healthy and there’s no evidence of the really bad effects of smoking, like emphysema.”

Only about 20 percent of smokers actually develop the worst effects of smoking, noted Hachem.

“It is certainly counterintuitive to say we’re going to use lungs from a donor with a smoking history, but the majority of people who smoke do not have lung disease,” said Hachem, who was not involved in the study.

Some people may have smoked for a long time years ago, then stopped, vastly improving the health of the organs. Others could have been active smokers when they died. The data in the study didn’t include that history, Taghavi said.

Freeing up smokers’ lungs could help reduce a shortage that has left more than 1,650 people on the transplant waiting list -- the “last resort” for those with end-stage lung disease, according to the National Heart Lung and Blood Institute. There were nearly 5,200 liver transplants in the U.S. in 2012, but typically only half the people on the list receive lung transplants in a given year, the NHLBI said. 

Taghavi emphasized that transplant recipients who get lungs from heavy smokers ought to be told in advance.

“This is a very important point,” he said. “None of this should be done without a thorough discussion with the recipient. They have to be aware that there are risks with accepting these lungs, but there are benefits.”

But Hachem said current practice usually doesn’t include that discussion.

Recipients decide in advance whether to take organs from high-risk donors, including those with a history of infections such as viral hepatitis or HIV. But behavior habits, such as smoking, are almost never disclosed, Hachem said.

“I don’t know what other centers do, but at our center, we don’t get into those details,” he said.

Instead, the organs are inspected carefully and only those found free of disease or disability are approved for transplant. “We’ve sort of screened the organ pretty well,” he said.

Of course, problems can occur. Widespread media reports last year centered on Jennifer Wederell, a 27-year-old British woman with cystic fibrosis who died of lung cancer last year after receiving lungs from a heavy smoker. In 2007, the family of a New Jersey man, Tony Grier, sued the University of Pennsylvania Health System after they said Grier developed lung cancer a month after a 2005 lung transplant. Court records show the case was settled in 2010.

Such cases are very sad -- but also very rare, said Hachem, who noted that all transplants carry inherent risks. And, he said, most transplant recipients are like Randy Cooke, 52, of Chatham, Ill., who received a new set of lungs in 2011.

Cooke, who was diagnosed in 2008 with a degenerative lung disease, said that by the time he was placed on the transplant waiting list, he would have accepted lungs from a heavy smoker -- gladly.

“If I’d have waited another three months, I don’t know if I’d be here talking to you,” he said.

If his lungs had come from a smoker, Cooke trusted that his doctors would have screened out any potential problems.

“You have to take a lot of times what you can get,” he said. “You don’t have a choice. Time is not on your side.”

 Related:

• Competition affects who gets a liver transplant
• Hand-me-down kidney transplanted twice in two weeks
• Best kidneys should go to right recipients, bioethicist says

For those who need another reason, beyond the ick factor, to not eat raw crawfish, here’s a frightening fact: many of these crunchy crustaceans carry the infinitely more icky lungworms – which can burrow from your digestive tract into your lungs, cheeks, or even your brain.

A new government report describes the cases of nine Missouri folks whose bodies were invaded by the parasitic little flat worms, officially known as paragonimus kellicotti, after gobbling down raw crawfish on a drunken dare.

All nine got infected with paragoniumus between 2009 and 2010. Before that, there had been just seven cases reported between 1968 and 2008, according to the new report published this week in Emerging Infectious Diseases, a Centers for Disease Control and Prevention journal. Why the upsurge? Turns out that people in the country’s interior like to cool off by rafting down rivers -- which are populated by crawfish. And someone, somewhere, got the brilliant idea to dare a friend to gobble down a live one.

“What we’ve seen is that out on rivers people like to drink and do some things we might not normally do,” says study co-author Michael A. Lane, an assistant professor of medicine in the division of infectious diseases at the Washington University School of Medicine. “We’ve seen a decent – though still relatively small – number of people eating raw crawfish on a dare after drinking beer.”

If you’re having trouble imagining someone consuming a live crawfish, just type the words “eating raw crawfish” into the search bar on YouTube and you’ll see plenty of people crunching away. Best to do this on an empty stomach. 

Scientists have discovered that many of the crawfish in Missouri’s rivers are infected with lungworms. “In some rivers as few as 40 percent of the crawfish had the parasite,” Lane says. “But in others it was as high as 70 percent. So, if you pull a crawfish out of the water, you’ve got a high likelihood of getting one with the parasite.”

The parasites are about the size of a grain of rice when they’re in a crawfish, Lane says. But they can grow as big as a half an inch once they’re inside the human body.

“After you eat the crawfish, the parasite comes out and migrates across the diaphragm,” Lane explains. “They burrow through the walls of the intestine, hoping to make it to the lungs where they can complete their life cycle and mature. Once in the lungs they form nodules that mature and grow. But sometimes they get lost on the way to the lungs and they can end up in other places. One of our patients had one that had gone to the brain. Another had one that had worked its way to the cheek.”

Lane’s study only looked at people who had been seen at his medical center, but Missouri isn’t the only place with hot weather, rivers and crawfish.

“All the pieces of the parasite’s life cycle are found throughout the country,” Lane points out. “There have been animal studies that have found them in Ohio, Colorado, and other places.”

Because of that, Lane suspects there may be even more cases of people out there with paragonimus symptoms – coughing, fever, shortness of breath, high white blood cell count, fluid in and around the lungs - who are being misdiagnosed with anything from tuberculosis to pneumonia to cancer.

And the misdiagnoses may cause more damage than the worm itself. One of Lane’s patients was on the verge of getting treated for cancer because doctors assumed that had to be the problem.

“He’d had multiple procedures for draining the fluid from his lungs – which eventually caused one of his lungs to collapse,” Lane says.

Another patient had a healthy gallbladder removed when doctors couldn’t find any other explanation for his chest pain.

The good news is that there is a very effective therapy. When patients take the medication praziquantel for three days, there is a 100 percent cure rate, Lane says.

The tricky thing is for doctors to first figure out whether a patient has the parasite since there is no good blood test.

“Probably the best diagnostic test we have is to ask the patient if they ate any raw crawfish,” Lane says. 

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