Single center series: Organ retrieval in donors suspected of cancer (2011)

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This study describes the issue of deceased brain dead donor (DBD) cancer screening protocols (CSP) and the limitations associated with such a protcol. The authors reviewed their own series of 75 potential and eligible DBD (2007-2010). In 22 cases (29%) either imaging findings, laboratory values or other lesions detected during procurement were suspicious for malignancy. In 15 cases histopatholigocal examination became mandatory with 1 case where results were inconclusive on frozen section: malignancy could not be ruled out or excluded and donation was aborted. The authors mention further that sometimes results of autopsy etc. were of limited quality (and not in time) for final conclusions whether a donor could have been used or not. 1) despite histopatholgical examination by frozen section a malignancy cannot always be ruled out or identified. In such intermediate results the procedure has to be stopped according to Polish national Guidelines 2) despite careful cancer screening protocol a residual risk remains that a donor transmittable malignancy cannot be detected (as well as donor derived malignancy cannot be ruled out) 3) the cancer screening rules effective in 2011 in Poland may increase the risk that otherwise suitable donors are not realized while knowing the deviation from standard risk donors. The Polish Guideline effective in 2011 include careful medical record review, examination of the donor (including imaging etc.), examination of thoracic cavitiy and abdominal cavitiy during any procurement with immediate histopathological examination of suspicious mass plus obtaining second opinion at Polish reference Center (Poltransplant) plus determination of tumor marker preprocurement. In any donor with abnormality, use of organs is prohibited. According to the authors this is in contrast to the Gudielines of other countries and in Europe (see Council of Europe Guide) where after proper risk-benefit assessment use of such donors is allowed when the risk does not become unacceptable regarding the event of tumour transmission.
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Single Center Series
DBD/donation after brain death
Histologic analysis
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Rudzki S, Bicki J, Matuszek M, Pilat J, Furmaga J, Borawska M. Organ retrieval in donors suspected of cancer: single-center experience. Transplantation Proceedings. 2011;43(8):2860-5.
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This study critizises that restrictive policies excluding donors with an increased risk for malignancy transmission decreases the donor pool while on the other side strict adherence to a cancer screening protocol (with immediate histopathological examination of suspectible masses when indicated) improves safety as well as that the residual risk to miss a malignancy in a donor persists despite any cancer screening protocol. The authors mention the issue, that in some cases despite frozen section and/or histopathological examinations malignancy cannot be ruled out or confirmed. Further determination of a single set of determination of tumour markers in a patient exposed to the critical condition of "brain stem coning process" may not be representative.