Cancer Transmission in Deceased Donor Organ Transplantation: An Australian Population-Based Linkage Study of Donor Referral Data.

Abstract

Cancer transmission risks from deceased organ donors to recipients may be overestimated, and there is often hesitancy in accepting potential donors with a history of cancer, regardless of absolute risk. We linked all persons referred for consideration for deceased organ donation (actual donors and potential donors forgone) and transplant recipients, 2010-2018, with the population cancer registry, 1976-2018, in NSW, Australia. We sought to estimate the transmission risk for common cancers (breast, prostate, colorectal) in deceased donors and identify missed opportunities for donation. Firstly, cancer transmission rates from actual donors were assessed. We then compared suspected cancer history during medical assessment with the cancer registry for those potential donors forgone. There were 165 cancer histories verified in 993 deceased donors, with one high-risk breast, six minimal-to-high-risk prostate, and no colorectal cancers. Organs from these seven donors were transplanted in 11 recipients (10 kidneys, 1 liver) with no evidence of 'Proven/Probable' cancer transmission after a median 6-years' follow-up. Additionally, 169/3588 (5%) potential donors were forgone for a suspected Common Cancer transmission risk. Of these, 6/169 (4%) had no cancer verified, and 39/169 (23%) had a verified cancer that was of minimal-to-low risk for transmission. Accepting these 45 additional donors would have increased donation rates by 5%. A balanced review of transmission and non-transmission events in organ donation, along with improved decision support, could inform current risk assessments and improve donation rates.