Doctors have reported a case where three patients died from breast cancer which they contracted from a single organ donor, a 53-year old woman with the disease whose kidneys, lungs, liver and heart were transplanted.
After suffering a stroke in 2007 the woman’s organs were donated to five people, but her diagnosis was not known to doctors and four patients contracted aggressive “donor derived” breast cancers.
A fifth recipient died within five months of receiving the heart transplant from sepsis, where the immune system starts attacking the body in response to a foreign organ or other serious infection.
The patients’ cancers were first noticed 16 months after the transplant, though others took as long as six years to spread and be picked up.
Using DNA testing doctors were able to match the genetic profile of the cancer cells in each patient with the original donor demonstrating that it had been cancerous cells in the transplant organs to blame.
Experts said there is approximately a one in 10,000 (0.01 to 0.05 per cent) chance of screening tests which check the suitability of donors failing in this way and transplanting an infected organ.
Dr Yvette Matser, from VU University Medical Center, The Netherlands, was lead author of the report in the American Journal of Transplantation, which notes: “The extremely low rate of transmission of malignancies during transplantation proves the efficiency of the current guidelines.”
It says using a CT scan to examine deceased potential donors thoroughly is impractical and increases the risk of false positives which would “shrink the already small donor pool”.
A medical exam, including a breast exam, to look for tumours is already recommended and should always be carried out.
In this case it is possible that keeping the donor organs warm allowed cancer cells to circulate more widely, they suggest.
The first patient to fall ill was a 42-year old woman who received a double-lung transplant, but by the time she was diagnosed the condition had already spread (metastasised) to her bones, and she died in 2009.
Doctors warned remaining patients about the risk and the man and woman who each received a kidney from the donor were tested, but only began to show signs of the disease several years later.
A male recipient had his kidney removed after a tumour was detected in 2011, he underwent chemotherapy along with stopping the immune system suppressing drugs taken by transplant recipients and is still cancer free.
The remaining two women, recipients of a kidney and liver, died after their cancers spread.
One of them, a 59-year old woman who received a liver, declined to have it removed when the tumour was first discovered because of fears of further complications.
Transplant recipients take powerful immune system suppressing drugs to prevent their organs being rejected and this can make it more likely that cancer cells are not wiped out.
“This extraordinary case points out the often fatal consequences of donor-derived breast cancer and suggests that removal of the donor organ and restoration of immunity can induce complete remission,” the authors wrote.
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