We certainly appreciate the experience of Starnes et al1 in lobar transplantation of living related donors. However, the main ethical issue raised in our article is what can one do with a large adult patient who requires a singlelung transplant. Moreover, although the risk of lobectomy is less, the procedure requires two donors, each with his or her own risk.
Indeed, we praise the excellent and ethical work done by Starnes and colleagues. What we suggested was that in certain locations (such as Israel) where donors are scarce, even pneumonectomy should be considered a possibility in order to save a close friend or relative.