Older adult multiorgan donors and misdiagnosed tumor

BACKGROUND: In these last years, the increase in organ donations is mostly due to old patients died of primary vascular cerebral diseases. In this kind of patients some undiagnosed cancers can be present and can be transmitted to the receiver. Aim of this study is to carry out a research in order to identify any undiagnosed cancer which can be present during the period of encephalic death. METHODS: Perspective study: hospitals type II and type III. Polyvalent intensive care. From January 1999 to July 2000 encephalic death has been ascertained in 16 patients. The research of tumor markers has been carried out on these patients. Further diagnostic researches have been carried out on patients who had anomalous values. RESULTS: The organ donations have not been made by eight patients: five for family refusal, one for medical contraindications, two for the presence of undiagnosed tumor (PSA 1100 ng/ml and CEA 129.5 ng/ml) confirmed by prostatic and abdominal US imaging. A patient with CA 19-9 89.5 ng/ml has not been examined, because of the family refusal to donation. A patient with PSA of 135 ng/ml had a negative response from the anal scanner, and so the prosecution of the donation has not been interrupted. A blood sample has been taken and a biopsy of the prostate has been made to confirm the absence of neoplasm. CONCLUSIONS: It is necessary to make a careful examination of the organ donor to check if some cancers are present. Tumor markers cannot be used to make a diagnosis of a cancer, but they can be used as guide for further researches. In spite of all the diagnostic efforts, the objective evaluation of the surgeon is still the most important factor like the biopsy of all the suspected lesions during an operation and the autopsy.