Registry series: Estimated risk of donor cancer transmission (UK Transplant Registry) (2014)

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.