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Last week, many news organizations reported that four people in Europe had developed breast cancer after receiving organ transplants from the same donor in 2007. Three died of the disease.
The case report that detailed these results, originally published in the American Journal of Transplantation Earlier this year, she explains how a 53-year-old woman succumbed to a stroke and gave her heart, kidneys, liver and lungs to four different transplant recipients. Although the donor does not have a documented history of cancer upon her death, DNA tests confirm that the cancers in the recipients come from the donor's body.
The spread of cancer from one donor to one recipient is "extremely rare," said Dr. Frederike Bemelman, author of the report. CNN. Only about one in 5,000 people who receive a transplanted organ will get cancer from this organ.
But there is always an unknowable risk, says Nicole Ali, a transplant nephrologist at the NYU Langone Transplant Institute. The infection and cancer are a constant concern. To protect patients and try to transplant as many organs as possible, specialists evaluate the risks and possible benefits of each heart, lung, liver, intestine, pancreas and kidney.
There is a chronic shortage of donated organs in the United States. In 2016, more than 7,000 people died while waiting for an organ transplant, according to the Unified Network for Organ Sharing. This year, more than 114,500 people are on the waiting list for transplants. Only 24,000 received new organs this year from 11,600 donors.
Once they have received a transplant, these patients take immunosuppressants – drugs that lessen the immune system's response – to prevent their bodies from rejecting new organs. Unfortunately, this makes transplant recipients much more sensitive to the rapid spread of cancers and viruses, including those who can hide in their new tissues.
To minimize risk, each donor goes through a careful selection process. But it is easier to test living donors than deceased donors.
Healthy people can donate a kidney or part of their liver or, more rarely, a lung. Before these people undergo surgery, they undergo rigorous tests while doctors try to learn everything about their bodies and their medical history. The Organs Supply and Transplant Network sets guidelines for all organ donations and recipients in the United States.
"We try to filter living donors as much as possible," says Ali.
Doctors examine women with breast or cervical cancer and men aged 40 to 50 for prostate cancer. Anyone over the age of 45 (guidelines have recently increased by 5 years) will need to have a colonoscopy. Doctors will be on the lookout for skin cancers, abnormal blood tests that might indicate something more rare, such as leukemia or lymphoma, and evaluate the health of the kidney or liver itself. If a person has a family history of lung cancer, she will check that, says Ali.
No one with a malignant tumor or a badly treated cancer can give an organ. But doctors are more likely to approach people with a history of cancer, with transplant specialists consulting with oncologists to assess the risk of transmission.
For example, someone with a history of basal cell skin cancer could probably donate, says Ali, because the basal cell is a simple cancer that rarely spreads to other parts of the body. In contrast, melanoma tends to return within five years, so the history of the disease tends to exclude a potential donor. This is only if someone was in remission for a long time – over 15 years – that doctors would consider it.
For some diseases such as breast cancer, it all depends on the type, the degree of cancer spread in the body and the time elapsed since cancer treatment without recurrence, says Ali.
"With the living donor, you benefit from the time and all this screening takes time," says Ali. Although there is always a risk of illness or infection, doctors have at least enough time to do their homework.
"Some cancers have a very low risk of recurrence, or [happened] Not so long ago, it is not unreasonable to consider using these organs, "says Ali. "And cancer excludes many, many organs, especially in the deceased donor population."
With a deceased donor, someone who has chosen to be an organ donor and who has been declared a brain dead but has not yet been removed from life, everything happens much faster. Doctors must promptly ask for the family's consent, then harvest the organs and transplant them into the recipient. Many organs can only survive a short time outside the body, Ali explains. Physicians must rely on the person's medical history and information provided by family members.
In the case of Europe, the donor had no history of cancer or visible signs of illness upon her death. The authors hypothesize that the donor could have had a whole-body cancer micro-metastasis – cancer cells so small that they were not detected during the woman's life.
The authors of the report debate the question of whether carrying a scanner on the body would have caught cancer. If the theory of micro metastasis is true, it probably would not be. There are many cancers that a scanner can not detect, says Ali, but the machine could detect non-cancerous lesions that could exclude a donation unnecessarily. The author has taken up these concerns in his report. They warn that post-mortem CT scanning could reduce "the already rare donor pool".
Transplant physicians need to think every day about the need to try to treat as many people as possible as safely as possible. These complex considerations are even more important in places like New York City, which has one of the lowest organ donation rates, although it is one of the most populous cities in the country, says Ali.
"Everything we do in medicine is a balance between risk and benefit," she says.
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