Article

Donor-Transmitted Malignancies in Organ Transplantation: Assessment of Clinical Risk

Division of Transplantation and Hepatic Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
American Journal of Transplantation (Impact Factor: 6.19). 06/2011; 11(6):1140-7. DOI: 10.1111/j.1600-6143.2011.03565.x
Source: PubMed

ABSTRACT The continuing organ shortage requires evaluation of all potential donors, including those with malignant disease. In the United States, no organized approach to assessment of risk of donor tumor transmission exists, and organs from such donors are often discarded. The ad hoc Disease Transmission Advisory Committee (DTAC) of the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) formed an ad hoc Malignancy Subcommittee to advise on this subject. The Subcommittee reviewed the largely anecdotal literature and held discussions to generate a framework to approach risk evaluation in this circumstance. Six levels of risk developed by consensus. Suggested approach to donor utilization is given for each category, recognizing the primacy of individual clinical judgment and often emergent clinical circumstances. Categories are populated with specific tumors based on available data, including active or historical cancer. Benign tumors are considered in relation to risk of malignant transformation. Specific attention is paid to potential use of kidneys harboring small solitary renal cell carcinomas, and to patients with central nervous system tumors. This resource document is tailored to clinical practice in the United States and should aid clinical decision making in the difficult circumstance of an organ donor with potential or proven neoplasia.

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Available from: Michael Ison, Aug 25, 2015
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    • "As with other donor selection criteria, it is crucial that potential recipients are warned of the risk, and that any organ might transmit malignancy, particularly if it is from a donor with a known history of malignancy, and that the recipient is fully informed and closely involved in the decision-making process. Recently, the subcommittee to examine donor-related malignancy transmission (Malignancy Subcommittee) of the Disease Transmission Advisory Committee (DTAC) of OPTN/ UNOS suggested risk categorisations for specific tumour types (Table 4) [81]. Benign tumours for which malignancy was excluded were reported to have no significant risk of disease transmission. "
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