For some stage IV lung cancers, both diseased lungs can be replaced with donor lungs: all 17 patients in a small study survived for one year
For some stage IV lung cancers, both diseased lungs can be replaced with donor lungs: all 17 patients in a small study survived for one year
At Northwestern, surgeons transplanted lungs into people whose non-small cell lung cancer, the most common type of lung cancer, had filled both lungs and caused respiratory failure but had not been detected in other organs. Among the 17 recipients, estimated one-year survival was 100%. Among 81 similar patients who continued medical treatment, it was 40.8%.
On July 8, JAMA published results from the Northwestern registry. Stage IV lung cancer usually means that the tumor has spread beyond the lungs. In some patients, it involves both lungs, but testing has not yet detected it in other organs. These patients cannot breathe because their lungs have stopped working, and available drugs, immunotherapy, and clinical trials have already been exhausted.
For these patients, Northwestern physicians tested a radical approach: remove both lungs together with the tumor and replace them with donor lungs. Before surgery, the team looked for even occult cancer spread using detailed imaging and sampling lymph nodes in the mediastinum, the space between the lungs. With the patient on cardiopulmonary bypass, surgeons removed both lungs and the lymph nodes at the same time, washed the airways and chest cavity, and then transplanted the donor organs.
The JAMA article describes a registry of 98 adults with this form of cancer. Seventeen received transplants. The other 81 met the medical criteria but did not undergo transplantation because of logistical, financial, or geographic barriers. No recipients died during the primary follow-up period. In the group receiving standard treatment, 52 people died within one year, and estimated survival was 40.8%.
Transplantation in this study was intended for a narrow group: the tumor had to remain confined to the lungs, all available treatments had to have stopped controlling it, and the patient had to be able to tolerate major surgery and lifelong immunosuppression. The small sample produces a wide confidence interval, from 63.1% to 100% for one-year survival after transplantation. By January 31, 2026, the cancer had returned in four of the 17 recipients, and two had died.
Donor organ availability is also central to the decision. At the same center, 88.1% of 306 patients who received lung transplants for other terminal diseases survived for one year. Every organ allocated to a person with cancer becomes unavailable to someone else on the waiting list. The issue is therefore not whether the operation is impressive. It is whether patients with cancer have a comparable chance of living for years and should receive scarce donor lungs.
Organ replacement medicine faces a specific problem: a fatal disease sometimes remains confined to one organ. In that situation, clinicians need to determine whether the entire affected organ can be removed before organ failure kills the patient.