The Tempest Surrounding Lung Transplant for Lung Cancer, With Lung Cancer, or With Isolated Lung Metastases

Lung transplantation for cancer is controversial. The hesitancy has largely been driven by historical outcomes. However, early-stage lung cancer does not significantly affect the outcome of lung transplant for other end-stage lung diseases. We have also made more donor lungs available and hence can consider transplanting patients where the only curative option is to resect both lungs. With careful patient selection, experienced transplant centers can achieve acceptable long-term lung transplant results in patients with cancer as compared to those with other end-stage lung diseases. Additionally, there are two ongoing trials investigating the role of lung transplant for lung cancer and aim to expand access to lung transplants for cancer patients and potentially change medical opinion. If more than one type of patient can benefit from transplant, is it ethical to only allocate donor allografts to patients with chronic lung disease simply because that is what we have always done? Is one disease process more deserving of treatment than another?