The Government's "transplant tsar" insisted today that organ transplants were carried out on the basis of whether they would work - after it emerged that a cystic fibrosis sufferer died after receiving the lungs of a long-term smoker.
Chris Rudge, national clinical director for transplantation, said smoking was not the "issue" in the case of cystic fibrosis sufferer Lyndsey Scott, whose family have lodged a complaint after she received a double lung transplant from a 30-year smoker.
The 28-year-old, from Wigan, underwent the double transplant at Wythenshawe Hospital in Manchester in January last year and died in the July from pneumonia.
Her family have said they were not told that the donor smoked - and she would have been "horrified" to discover the organs were from a smoker of 30 years.
Mr Rudge, who said he did not know the "full details" of the case, and was speaking more generally, insisted that it mattered "far more" if lungs were working properly than if they were from a smoker.
"Lungs from a smoker can be working perfectly normally and be perfectly suitable for transplantation lungs from a non-smoker can not be working and not be suitable for transplantation," he told BBC Breakfast.
"Surgeons have to make decisions - about four out of every five lungs that become available for transplantation are not used because they are not working well enough.
"It is nothing to do with the history of the donor, it is whether the organ is working or not, whether it is going to produce a successful transplant or not, and, in this particular case, smoking isn't the issue."
He added that people who go on the waiting list for transplants must be told that human organs that become available are not "brand new", perfect organs.
He added that surgeons and the patient should also discuss and come to a consensus if a particular organ carries particular risks - but that surgeons were working within tight time constraints.
Miss Scott is said to have undergone the transplant surgery to prolong her life after her condition deteriorated.
Her family were reported to have found out that the lungs came from a long-term smoker after applying for the medical notes on the operation.
"I can honestly say she would have been horrified to have known those lungs were from a smoker and quite definitely she would have refused that operation," Allan Scott, her father, told the BBC.
"I understand that in human organs there is no such thing as a perfect organ.
"It's not like if you have something wrong with your car and your car breaks - you get a new part for that car. There are no new parts for organs, I appreciate that."
A spokeswoman for the University Hospital of South Manchester NHS Foundation Trust (UHSM) said it had followed national guidelines.
A statement from the trust said it would not be able to comment on the case while the trust responds to an official complaint made by the family.
"At UHSM we follow guidelines for organ retrieval which are based on the national guidelines set by UKTS (the UK Transplant Service) formerly, now NHSBT (NHS Blood and Transplant).
"The issue of recipient choice has also been thoroughly reviewed in our unit in the past 12 months.
"There is a standard criteria for accepting a donor organ(s), on the basis on clinical evidence, which forms part of the discussion with patients at their assessment.
"Because the number of lung donors is extremely low and 30% of lung recipients die before getting a transplant, UHSM and other transplant centres have extended their criteria.
"This is increasing the number of viable lungs available for donation that are still considered to be 'safe'.
"In the event that there are factors or issues surrounding the donor which are deemed to make the donation of higher risk, we will discuss these concerns directly with the recipient, e.g. drug use or a particular event in the donor's life.
"At UHSM we have an excellent track record in successful organ transplantation and our programme has one of the lowest early mortality rates in the UK."
Joyce Robins, co-director of Patient Concern, told BBC Breakfast: "Most patients would say that they should be informed of any pertinent fact. If the family are saying that she would have refused a transplant had she known, then that is an important issue."
She added: "You can't buy a pair of nice new organs from a shelf.
"They have all been used somehow, and therefore it is viability that is important, it is for the surgeon to put that to the patient and say 'We believe that these are good lungs and they will do you well'.
"It is for the patient to say ' Well, OK, I'll take my chance, that is fine'... or to say 'No, thank you, I would prefer not to do that'."