Four in 10 lungs used in transplants come from donors who smoked, the Sunday People can reveal.
But the organ shortage means patients have to accept them - or risk dying if no others become available.
It raises fears patients could end up with lungs from chain-smokers like EastEnders favourite Dot Branning, played by June Brown, 85 - who continue to puff away despite danger warnings on cigarette packs.
Soldier Corporal Matthew Millington, 31, died less than a year after being given the cancerous lungs of a donor who smoked up to 50 roll-ups a day.
Cpl Millington, of the Queen's Royal Lancers, had the double transplant at Papworth Hospital, Cambridge, in April 2007. Months later doctors found a tumour and he died in February 2008.
Cystic fibrosis sufferer Lyndsey Scott, 28, from Wigan, had a double transplant at Wythenshawe Hospital, Manchester, in January 2009 and died from pneumonia a month later. Her family said they were not told that the organs were from a smoker of 30 years.
Health minister Earl Howe, who revealed 39 per cent of transplant lungs were from smokers, insisted patients were still better off accepting them. But he told the House of Lords: "The transplant team should explain the risks."
Since April, 1,859 people had a transplant. But there are still 7,603 on the waiting list and only 759 new donations in that time.
Specialist nurses take a smoking history from donors' families and the transplant team then decide whether the lung is suitable.
An NHS Blood and Transplant spokeswoman said: "Transplant candidates are offered the opportunity to decline them. But choosing to wait may mean a greater risk of dying before alternative lungs become available."
SMOKERS are less than half as likely to get a date, with "ashtray breath" cited as the biggest turnoff in a Letsquit.com poll.