Registry Series: Donor cancer transmission by organ transplantation. Australian experience (2021).

Ready to upload
Record number: 
Adverse Occurrence type: 
Estimated frequency: 
A variety of tumor types are included, with a focus on renal cell carcinoma and CNS tumors. Reference to records discussing the particular tumor types is sugested for current recommendations.
Time to detection: 
N/A. The study is a population study linking data from the Safety and Biovigilance in Organ Donation (SAFEBOD) Public Health Register to identify cases of transplant tumor transmission, and the New South Wales (NSW) Central Cancer Registry to detect all possible cases of donor cancer. 38 donors with past or current cancer provided organs for 68 recipients. There were 4 transmissions and 64 non-transmissions. All 4 transmissions were renal cell carcinomas with diagnosis times of 6 months, 8 months,2 years and 3 years.
Alerting signals, symptoms, evidence of occurrence: 
Case 1: (Deceased donor) Kidney adenocarcinoma resected, allograft kidney failed after 8 months due to tumor. Case 2: (Deceased donor) Kidney adenocarcinoma not further described, kidneys discarded. Lung transplant recipient developed metastatic adenocarcinoma of uncertain origin 6 months posttransplant, leading to death. Case 3: (Living donor) Kidney adenocarcinoma not further specified, recipient developed renal cell carcinoma 2 years posttransplant. Case 4: (Living donor) Renal cell carcinoma resected, recipient developed metastatic renal cell carcinoma 3 years posttransplant; no further information, including donor vs. recipient origin, available.
Demonstration of imputability or root cause: 
Link of data of registry & case definition
Imputability grade: 
2 Probable
Groups audience: 
Suggest new keywords: 
Registry Series
Deceased donor
Living donor
Renal cell carcinoma
Therapy discussed
Lung transplant
Lung recipient
Kidney transplant
Kidney recipient
Oligodendroglioma (WHO grades 2-3)
Astrocytoma/glioblastoma multiforme (WHO grade 4)
Reference attachment: 
Suggest references: 
Hedley JA, Vajdic CM, Wyld M, Waller KMJ, Kelly PJ, De La Mata NL, Rosales BM, Wyburn K, Webster AC. Cancer transmissions and non-transmissions from solid organ transplantation in an Australian cohort of deceased and living organ donors. Transpl Int. 2021 Sep;34(9):1667-1679. doi: 10.1111/tri.13989. PMID: 34448264.
Uploaded 5/3/22 MN first review CLFF 5/30/22 Note: when I worte "see original article for details", then it was reported about metastasis or unacceptable condition per se - in this case I intended not to write down all details, so the people msut go into the orginal reference & we keep the risk of not reading the details and not considering all well low - hopefully. When you are not happy, we can expand. Second review: MN 1/23/23
Expert comments for publication: 
This study links donor cancer data from a regional Cancer Registry with transplant cancer transmission events derived from a separate Registry and this results in an overall transmission rate of 0.16% of all organ transplant procedures. Examples of donor cancers that did not result in transmission in individual cases include: 2 cases of breast cancer diagnosed 4 and 6 years prior to donation, a separate donor with kidney and metastatic breast cancer diagnosed 1 year prior to donation, 2 donors with thyroid cancer, and 4 donors with current or past melanoma (1 in situ melanoma, one with a 0.13 mm Breslow thickness tumor removed 2 years prior, and 2 with thickness not reported). In addition, no transmissions were seen with organs from 7 donors with brain cancer, including 4 with glioblastoma, 1 with oligodendroglioma, and one with glioma of unknown grade. The authors note the data limitations of Registry data, and suggest that organs from carefully selected donors with current or past history of cancer can be used for transplantation. It is notable that several of the renal carcinoma transmissions occurred following resection of the donor tumors; details are not available and this underscores the care necessary to ensure attention to complete donor tumor resection and consideration of tumor size and histology at the time of transplant. The absence of melanoma transmission in the cases of small or in situ lesions is also informative. It must be kept in mind that anecdotal examples such as these show that the risk of transmission is not 100%, but conversely do not support the position that the transmission risk is 0%, and the authors appropriately suggest considering patient wishes and balancing, to the best of our ability, the tradeoffs between perceived risk of transmission versus remaining on the wait list.