Occult donor metastatic adenocarcinoma. Contribution of the forensic autopsy. A case report

TitleOccult donor metastatic adenocarcinoma. Contribution of the forensic autopsy. A case report
Publication TypeJournal Article
Year of Publication2010
AuthorsBadia Castello M, Trujillano Cabello J, Servia Goixart L, Tarragona Foradada J, Panades Siurana MJ, Amoros Galito E
JournalAnn Transplant
Pagination67 - 71
Date Published43525
ISSN1425-9524 (Print) 1425-9524 (Linking)
Accession Number20305322
Keywords*Tissue Donors, Adenocarcinoma / complications / *etiology / pathology, Aged, Autopsy, Brain Death / pathology, Humans, Kidney Transplantation / *adverse effects, Male, Neoplasms / complications / *etiology, Nephrectomy / *adverse effects, risk

BACKGROUND: The transmission of malignancies from the organ donor to the recipients is an uncommon complication, but it can be fatal. Older donors may increase the risk of tumor transmission. A forensic autopsy will help identify diseases that might be transmitted to the recipient. CASE REPORT: Donor was a 75-year-old man with traumatic brain injury caused by an accidental fall, which led to brain death. He had no previous cancer history. The forensic autopsy conducted on the following day revealed a suspicious spot in the lung, on which a biopsy was done. Histological examination confirmed the presence of a metastatic adenocarcinoma in the lung 7 days after both kidneys had been transplanted. After notifying the transplant team, both recipients underwent an early transplant nephrectomy. 15 months later, no signs of malignancy have been detected in the recipients and so they have received a new transplant. CONCLUSIONS: Conducting a forensic autopsy on donors deceased as a result of a fatality offers an additional opportunity to detect previously undiagnosed malignancies. Any suspicious lesion found that could compromise transplant viability should be notified to the transplant team notwithstanding the pathologist's legal requirements. This case shows the need for an exhaustive donor evaluation, including, in selected cases, the performance of an autopsy.

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