Registry series: Estimated risk of donor cancer transmission (UK Transplant Registry)

Status: 
Ready to upload
Record number: 
1909
Estimated frequency: 
N/A
Time to detection: 
The following are current recommendations for donor tumors discussed in this article (see also expert comments) Breast cancer: Most recent risk assessment for breast cancer (Council of Europe, 2022): Newly diagnosed invasive breast cancer is an unacceptable risk for organ donation. Organs from donors with invasive breast cancer might be accepted in selected cases after full treatment, complete remission and stringent follow-up for > 5 years, depending on the initial stage and E/P and HER2/neu receptor expression, always bearing in mind the risk of transmission due to possible late metastases. Breast cancer stage 1 (AJCC, 8th edition) [18] with curative surgery and cancer-free period > 5 years seems to be associated with low to intermediate risk for transmission. All other invasive breast cancer stages are considered high-risk for transmission, independent of the presumed recurrence-free survival and treatment. Melanoma: Most recent risk assessment for melanoma (Council of Europe, 2022): Due to the very aggressive behaviour of this tumour, it is considered an unacceptable risk for organ donation. Malignant melanoma in the donor history: Due to the lack of exhaustive data, transplanting organs from donors with treated malignant melanoma must still be considered to be associated with a high transmission risk. If precise donor data about staging, therapy, follow-up, and recurrence-free survival are available, and evaluation by the dermato-oncologist concludes there is a low probability of recurrence and metastasis, organ donation might be considered for selected recipients. Ovarian cancer: Most recent risk assessment for ovarian cancer (Council of Europe, 2022): Ovarian cancer is considered an unacceptable risk for organ donation. Ovarian cancer in the donor history: Treated ovarian cancer is considered high-risk for organ donation. Depending on initial stage, grade, therapy and time of recurrence-free survival (> 5 years), the risk category might decrease individually. Colon cancer: Most recent risk assessment for colorectal cancer (Council of Europe, 2022): Acceptance of pT1-tumours – see AJCC, 8th edition [18] – Donors with pT1 tumours should only be accepted for organ donation with the utmost caution, and a high transmission risk must be assumed. Patients with higher stages of newly diagnosed, active colorectal cancer should not be accepted for organ donation (unacceptable risk). Colorectal cancer in donor history: The presence of pT1/pT2 (Dukes’ A or B) colorectal carcinoma (infiltration of submucosa/muscularis propria) in the donor without lymph node or distant metastases is assumed to have a low transmission risk after adequate treatment and disease-free survival of > 5 years. Risk increases with stage, and probability of presumed cure has to be taken into account.
Alerting signals, symptoms, evidence of occurrence: 
N/A
Demonstration of imputability or root cause: 
N/A
Imputability grade: 
0 Excluded
Groups audience: 
Suggest new keywords: 
Donor cancer without transmission
Registry series
Deceased donor
Living donor
Breast cancer, other or type not specific
Large bowel adenocarcinoma
Colon adenocarcinoma
Ovarian/fallopian tumor, other or type not specified
Melanoma
Suggest references: 
Desai R, Collett D, Watson CJE, Johnson P, Evans T, Neuberger J. Estimated risk of cancer transmission from organ donor to graft recipient in a national transplantation registry. The British journal of surgery. 2014;101(7):768-74.
Note: 
Pease clone this record for the following tours: melanoma, ovarian cancer, colon cancer - OK (EP) Reviewed 7/26/19; OK to upload MN
Expert comments for publication: 
This study suggests changes to classification of some donors with historical cancers (melanoma, breast cancer, ovarian cancer, colon cancer- details below). The study looked at living and deceased organ donation from January 1990 through 31 December 2008 as based on the UK Transplant Registry and compared it to data from the English National Cancer Data Repository. It focused on donors with a history of cancer documented prior to the day of donation and included all recipient cancers diagnosed after transplant. 202 of 17,639 donors had a history of cancer. Of these, 61 had cancers classified as unacceptable/high risk of transmission. Eight recipients developed cancer and all were of a type different from that of the donor and presumed to represent de novo malignancies. No difference in unadjusted survival or risk-adjusted hazard of death was seen when recipients of organs from donors with unacceptable/high risk tumors were compared to donor classified as standard/non-standard risk of cancer transmission. The authors estimate that 944 life-years were gained by use of these organs at 10 years, with a mean survival of 7.1 years per recipient. On the basis of the study they suggest that current rules are overly stringent and suggest the following changes to guidelines for donors with a history of cancer, proposing the following criteria to represent acceptable risks: 1: melanoma- superficial spreading type, tumor (Breslow) thickness <1 mm, curative surgery and minimum cancer-free period of 5 years. 2: Breast cancer- Stage I, hormone receptor-negative, curative surgery, minimum cancer-free period of 5 years. 3: Ovarian cancer- curative surgery, minimum cancer-free period of 10 years. 4: Colon cancer- curative surgery, minimum cancer-free period of 5 years.