IS ORGAN DONATION POSSIBLE IF THE DONOR HAS CANCER ?

There is an increasing demand for organ transplants because of a dramatic rise in the number of patients who have organ failure and can benefit from an organ transplant. Transplant physicians, in order to alleviate this critical shortage are always looking for ways to increase the number of people who could potentially be organ donors. One way to expand this pool is to consider a donor who has cancer. This can be detrimental in certain kinds of malignancies where it has been shown to spread from the donor to the recipient. However, when carefully screened, there are a number of donors who have a history of cancer who can qualify to become organ donors.

Based on numerous studies, certain types of cancers fall into the minimal risk category, where there is a < 0.1 % chance of cancer transmission from the donor to the recipient. These include:
a) basal cell carcinoma of the skin
b) squamous cell carcinoma of the skin without metastases
c) other early skin cancers that are not melanomas
d) early cervical cancer
e) early vocal cord cancer
f) superficial, non-invasive bladder cancer
g) small papillary or follicular thyroid cancer
h) small, early stage renal cell cancer which have been removed

Low risk category has a 0.1 to 1 % transmission risk. This includes the following cancers:
a) small, early stage renal cell cancer (slightly bigger in size, 2.5 cm, removed)
b) low grade brain or spine tumors
c) slightly larger papillary or follicular thyroid cancers
d) treated cancer more than 5 years prior with a > 99 % possibility of cure

Intermediate risk category (1 to 10 % transmission risk) includes:
a) early breast cancer
b) early colon cancer
c) removed renal cell cancer, 4-7 cm, early stage
d) treated cancer more than 5 years prior with a 90 – 99% chance of cure

High risk category (> 10 % transmission) includes:
a) Malignant melanoma
b) Active breast or colon cancer, higher than stage 0
c) Choriocarcinoma
d) Advanced brain or spinal tumors
e) Leukemia or lymphoma
f) Any cancer that has spread or metastasized
g) Sarcoma
h) Lung cancer
i) Advanced renal cell cancer
j) Neuroendocrine tumor

It must be mentioned that accepting donors with any history of previous cancers is a complicated problem. The decision to proceed with transplantation should be made with as much information that can be found on that particular donor’s medical history and after consultation with a cancer specialist and the transplant team. The list above is meant to serve as a risk assessment tool and the final decision is made after careful deliberation. Sometimes, if the transplant is urgent and the donor’s history is unknown, inadvertent transmission of cancer can occur. However, such incidents are extremely uncommon and the potential benefit of receiving an organ that can save a life is immense.