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Adverse Occurrence type:
(Council of Europe, 2018): Potential donors with pilocytic astrocytoma (WHO grade I) may be considered for organ donation with minimal risk of transmission. Extra-neural metastases from low grade astrocytomas (WHO grade II) are rare, and have been associated with resection and ventriculo-peritoneal shunts. In the absence of these risk factors the donor may be considered minimal risk. Risk may increase with the extent of performed interventions. A complete histological examination of the tumour should be performed so that areas of more aggressive malignancy are ruled out. Since astrocytomas have a tendency to relapse with a histologically higher grade of malignancy, new histological examinations should be performed where relapse occurs to regrade the tumour. If the tumor co-exists with histological areas of greater malignancy or is very invasive locally, it should be considered high grade and will be associated with an increased risk of transmission. Spontaneous extra-neural metastases of anaplastic astrocytomas and glioblastoma multiforme are rare, but have been observed, and occur more frequently when associated with prior surgical treatment and/or ventriculo-peritoneal drainage, or chemo-/radiotherapy. Potential donors with anaplastic astrocytomas (WHO grade III) can be accepted as organ donors. Transmission risk is considered low to intermediate for tumours without any risk factors. Potential donors with glioblastoma multiforme (WHO grade IV) are considered intermediate to high risk for transmission depending on the different national recommendations, which are expected to be adjusted with increasing evidence. The transmission risk is increased (high risk) in all cases with previous interventions such as tumour resection, ventriculo-peritoneal/-atrial drainage and/or cranial chemo-/radiotherapy.
Time to detection:
N/A: Organs not used due to diagnosis of glioblastoma multiforme in donor.
Alerting signals, symptoms, evidence of occurrence:
Demonstration of imputability or root cause:
Suggest new keywords:
Astrocytoma/glioblastoma multiforme (WHO Grade IV)
Punnett AS, McCarthy LJ, Dirks PB, Hawkins C, Bouffet E. Patients with primary brain tumors as organ donors: case report and review of the literature. Pediatric blood & cancer. 2004;43(1):73-7.
Expert comments for publication:
Timely case report from 2004 of an 11 year old boy who died with grade IV astrocytoma (glioblastoma multiforme) and whose organs (except for heart valves and pancreatic islets) were declined for transplantation. The authors review the published risk assessments for donors with CNS tumors available at that time and conclude that the risk was likely overstated and additional data were needed to more accurately define risk. They argue for considering such donors in light of the large number of potential transplant recipients dying on the wait list at that time.