A landmark Northwestern Medicine study published in JAMA reveals that double lung transplants can dramatically extend survival for select patients with terminal, stage 4 lung cancer. While hospitals historically rejected cancer patients due to recurrence risks, Northwestern successfully transplanted 17 patients whose cancer was strictly confined to their lungs. All 17 survived at least one year, compared to under half of those on standard therapies, sparking debate over the ethics of allocating scarce organs to terminal patients.
Lung transplants for cancer
- ▪Northwestern Medicine surgeons adapted techniques from performing lung transplants on COVID-19 patients to avoid spilling cancer cells into the chest cavity or bloodstream during lung removal
- ▪Northwestern Medicine surgeons performed double lung transplants on 17 patients with terminal lung cancer whose disease was confined to their lungs and who had exhausted other treatment options
Patient survival outcomes
- ▪Fewer than half of the 81 to 89 patients with advanced lung cancer who received standard medical therapies survived to the one-year mark
- ▪All 17 terminal lung cancer patients who received lung transplants at Northwestern Medicine survived for at least one year after their surgeries
- ▪Among the 17 lung cancer transplant recipients, four experienced cancer recurrence and two died from non-cancer complications, including an infection and a blood clot, by January 2026
Organ allocation ethics
- ▪Medical ethicists note that allocating scarce donor lungs to advanced cancer patients operates within a zero-sum system, making those organs unavailable to other candidates
- ▪Dr. Ankit Bharat argued that transplants are a justifiable use of organs because early outcomes for carefully selected cancer patients showed no significant difference compared to non-cancer transplant recipients
Patient selection criteria
- ▪Lung transplants are restricted to patients whose advanced lung cancer has not spread beyond the lungs and who have exhausted all standard treatments like chemotherapy and immunotherapy
- ▪The population of patients in the United States with stage 4 non-small cell lung cancer that remains confined to the lungs is estimated to be approximately 300 cases per year
Jodi Graf case study
- ▪Jodi Graf, a 61-year-old NASA robotics software developer with progressive pulmonary fibrosis, was diagnosed with a cancerous lung mass in 2020 while being evaluated for a lung transplant
- ▪Jodi Graf underwent a successful double lung transplant at Northwestern Medicine on Thanksgiving Day in November 2023 after biopsies confirmed her cancer had not spread beyond her lungs
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