Rarely, but it happens

Four organ recipients were "infected" with cancer from a donor

Anna Kerman, XX2 century

Doctors report an unusual case from practice: three patients died from breast cancer received from an organ donor (Matser et al., Transmission of breast cancer by a single multiorgan donor to 4 transplant recipients, American Journal of Transplantation, 2018). All the deceased patients were recipients of organs of a 53-year-old woman who died of a stroke in 2007. However, neither doctors nor patients knew that the deceased also had breast cancer, which she "transferred" to four out of five recipients.

A fifth patient who received a heart from the same woman died five months after the transplant as a result of complications from the immune system. As for the rest of the recipients, the first case of cancer was diagnosed among them 16 months after transplantation.

Using DNA analysis, the doctors compared the genetic profile of the cancer cells of the patients with the profile of the donor and found that the cause of the disease was the presence of cancer cells in the transplanted organs.

Experts say that the probability of error when passing tests for the suitability of donor organs for transplantation is only 0.01–0.05%. Dr. Yvette Matser from the Medical Center of the Free University of Amsterdam (Vrije Universiteit Amsterdam Medisch Centrum), the lead author of the article, explains: "An extremely low percentage of cases of transmission of malignant neoplasms during transplants proves the effectiveness of the existing rules."

The publication also says that the use of computed tomography to examine potential post-mortem donors is impractical, in addition, it will increase the risk of false positive results, which "will reduce the already small circle of donors."

A medical examination, including a breast examination in search of tumors, is already included in the recommendations and must be carried out without fail. It is also possible that keeping donor organs warm helps cancer cells spread more widely than if the organs were stored in the cold.

A 42-year-old woman who received both lungs from a donor was the first to get sick after transplantation. By the time of diagnosis, the tumor had already metastasized to the bones, and in 2009 the patient died.

The doctors warned the other recipients about the possible risk. The man and woman to whom the deceased's kidneys were transplanted underwent the necessary studies, but in these patients the disease began to develop only a few years later. In 2011 – after the discovery of the tumor, the donor kidney of the man was removed. He underwent chemotherapy and stopped taking immune suppressing drugs, now this patient has no signs of cancer.

The remaining two women, kidney and liver recipients, died of metastatic cancer. One of these patients refused to remove the donor liver, fearing further deterioration of the condition.

All recipients are forced to take powerful medications that suppress the immune system. This is necessary to prevent rejection of someone else's organ. On the other hand, immunosuppression increases the chances of cancer cells to survive.

"This extraordinary case shows that breast cancer transmitted from a donor can lead to fatal consequences, but removal of the donor organ and restoration of immunity can result in complete remission."

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