Although the risk of malignancy transmission has been understood and reported since the first years of clinical transplantation, donors with known malignancy or with a high risk of malignancy have thus been screened and avoided. The frequency of donors with malignant tumors are thus not known with precision since it is only through failures and unusual circumstances that transmissions have been reported. The limited information on such risks leads to the standard approach to consideration of individual / undocumented situations, based on a number of principles, as follows:
Diagnosis: A diagnosis of cancer in the donor, which may be definite (known histology), or probable (diagnosis reported by a third party).
Biological behaviour of the tumour: The characteristics of the expected biological behaviour and prognosis of the specific cancer in the normal population.
a) A cancer that has the potential to metastasise in the normal population should be a contra-indication to donation.
b) Exceptions are made specifically to permit donation from donors with a history of malignancy: skin cancers that do not metastasise in normal population e.g. basal cell carcinoma; and some central nervous system (CNS) malignancies that are known to be contained in the specific individual donor within the blood brain barrier through absence of intervention.
Tumour therapy performed / current follow-up: Consideration is made of specific cancers where the diagnostic evidence is explicit, but curative treatment and disease-free intervals are definitely observed such that the risk of metastasis in the normal population is minimal. Specific cancers that may behave differently in the immunosuppressed populations are excluded even if they meet this criterion e.g. melanoma, Kaposi’s sarcoma. A literature review performed in NOTIFY sought to review the current knowledge on risks of malignancy transmission through the transfer of MPHO and intended to determine if the principles outlined above do or do not provide a continuing basis for assessing the transmission risk for malignant disease. This information was mainly derived from dedicated follow-up registries, particularly in the field of organ transplantation e.g. the Australian and New Zealand Dialysis and Transplant Registry, the Centro Nazionale di Trapianti Tumour Registry, the Danish Tumour Registry, the Israel Penn International Transplant Tumor Registry, the Organización Nacional de Trasplantes Tumour Registry, and the United Network for Organ Sharing Registry.
The review of the published information (mainly case reports) also intended to serve for outlining the clinical manifestations of transmitted malignancies and providing guidance on how to determine the likelihood of malignancy transmission. As a result of the aforementioned literature review, a list of reported MPHO transmitted malignancies is provided in Table 4.
Table 4. List of malignancies for which at least one report on transmission through the transfer of MPHO has been identified.
|Cornea||Organs||Hematopoietic Stem Cells|
Renal Cell Carcinoma
Bladder Cancer – urothelial carcinoma