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Donors With Previous Malignancy: When Is It Safe to Proceed With Organ Transplantation?
Vitor Turra1, Joao Manzi1, Sarah Rombach1
1Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, FL, United States.
Abstract:
The growing number of organ donors in the United States, from 14,011 in 2012 to 21,374 in 2022, highlights progress in addressing the critical issue of organ shortages. However, the demand remains high, with 17 patients dying daily while on the waiting list. As of August 2023, over 103,544 individuals are awaiting transplants, predominantly for kidneys (85.7%). To expand the donor pool, the inclusion of elderly donors, including those with a history of malignancies, is increasingly considered. In 2022, 7% of all donors were aged 65 and above, despite the complexities their medical histories may introduce, particularly the risk of donor-transmitted cancer (DTC). This review examines the challenges and potential benefits of using donors with known malignancy histories, balancing the risks of DTC against the urgency for transplants. A critical analysis is presented on current knowledge and the decision-making processes that consider cancer types, stages, and patient survival outcomes. The goal is to identify missed opportunities and improve strategies for safe and effective organ transplantation from this donor demographic.
Insights
Organ donation is increasing, but shortages persist. Utilizing elderly donors with cancer histories may expand the donor pool, but requires careful risk assessment for donor-transmitted cancer (DTC).
Area of Science:
- Transplantation immunology
- Oncology
- Public health
Background:
- Organ donation in the US increased 50% from 2012 to 2022, yet 17 patients die daily awaiting transplants.
- Over 103,544 individuals are on the transplant waiting list (August 2023), with 85.7% needing kidneys.
- Elderly donors (≥65 years) are increasingly considered to expand the donor pool, despite potential malignancy histories.
Purpose of the Study:
- To review the challenges and benefits of using donors with malignancy histories.
- To analyze the risk of donor-transmitted cancer (DTC) versus the need for organ transplants.
- To improve strategies for safe organ transplantation from elderly donors.
Main Methods:
- Literature review of current knowledge on donor-transmitted cancer (DTC).
- Analysis of decision-making processes for utilizing donors with malignancy histories.
- Examination of cancer types, stages, and patient survival outcomes.
Main Results:
- In 2022, 7% of organ donors were aged 65 and above.
- Using donors with malignancy histories presents complexities, including the risk of DTC.
- Balancing DTC risk with transplant urgency is crucial for decision-making.
Conclusions:
- Careful consideration of cancer history, type, stage, and patient outcomes is essential.
- Strategies for safe organ transplantation from elderly donors with malignancy histories need improvement.
- Expanding the donor pool through this demographic requires balancing risks and benefits.
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