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It is not uncommon for infectious diseases to be transmitted from donor to recipient during an organ transplant, but in an extremely rare case, four Britons developed breast cancer several years after receiving organs from the same donor , despite extensive testing, according to a recent medical report.
Three of the recipients died after the cancer spread from organs to other parts of the body. The donor, a 53-year-old woman who died of a stroke in 2007, had no known illness, said the April issue report in the American Journal of Transplantation. Tests performed at the time of transplantation did not reveal any signs of breast cancer. Four of his organs – kidney, lung, liver and heart – were removed.
"No screening test is perfect, so there is no way to eliminate the risk at zero."
Cancer screening is important for transplant recipients because they present a higher risk of developing and dying of cancer than the general population. Receptors receive immunosuppressive drugs to prevent their bodies from attacking their new organs. The disadvantage is that damaged cells that would normally be destroyed by the immune system are also allowed to live.
"There is a reason that someone with cancer who did not know that he is an organ donor," Dr. Carlo Contreras, surgical oncologist and professor, recently told NBC News. Assistant at the University of Alabama in Birmingham.
But he and others have noted that the data available are limited to suggest that it is more than a coincidence.
"Cases of cancer transmitted at the time of transfer from an organ to recipients are extremely rare," said Dr. Steven Flamm, medical director of the liver transplant program at Northwestern Memorial Hospital. "In the United States, there have been hundreds of thousands of organ transplants, and the number of reported cases is almost nil. Yet, no screening test is perfect. A mammogram may not detect a very small cancer. There is therefore no way to eliminate the risk to zero.
Transplant patients face a higher risk of cancer and reduced life expectancy. However, cancer screening in donors is controversial because CT scans and other radiology tests could damage the organs to be transplanted and the donor family has to bear the considerable cost of testing.
Flamm, who did not participate in the case study, says the transplant doctors are vigilant about warning patients of these rare possibilities.
"We have educational sessions where the entire transplant procedure is discussed in detail, including these extremely rare incidences," said Flamm. "We discuss these implications and the risks of the procedures and medications that will need to be taken later in the assessment and again when the liver transplant is offered to the patient."
Contreras added that surgeons and support staff "ensure that patients undergo all recommended screenings, including mammography, colonoscopy, Pap smear and CT scan.
The organ procurement and transplantation network requires interviews with the next of kin and close friends of the donor to learn about the donor's medical history and information about behaviors that may have exposed the donor to certain diseases. . Laboratory tests for infectious diseases such as HIV, hepatitis B or C, syphilis, cytomegalovirus and Epstein-Barr virus are also performed routinely.
"Given the limited available data on cancer screening in solid organ transplant recipients, most of the recommendations are generally similar to the guidelines available to the general population," writes Dr. Nancy Baxter of the United States. Institute of Health Policy of the University of Toronto. relationship with his colleagues.
Flamm encourages families to conduct their own research before considering an organ transplant, but also believes that the benefits of organ transplant far outweigh the risks.
"For very sick patients, such as those who need a liver or pancreas, organ donation is a last resort. The qualification criterion for transplantation is a 50% probability of dying in the next 90 days, so patients are willing to accept these risks.
In the United States, the success rates of organ transplants are high, with most liver transplants, for example, having a one-year survival rate of 86%. Most patients lead a normal life afterwards.
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