Transplant Rethink Urged After Brain Tumor Donors Found Safe
Receiving an organ donation from a person who died with a primary brain tumor does not appear to carry an increased risk of cancer for the recipient, suggests a UK study than opens up the possibility of increasing the pool of organ donors.
The results of the study “suggest that the risk of cancer transmission from donors with primary brain tumors was lower than that previously thought,” said Christopher J.E. Watson, MD, Department of Surgery, University of Cambridge, Cambridge, United Kingdom, and colleagues.
It was published online on March 22 in JAMA Surgery.
The findings may particularly have an impact in countries with conservative guidelines for transplant donors, including the United States, the authors comment.
Currently in the US, 17 patients die every day while “waiting for a potentially lifesaving organ transplant, and many more remain on kidney dialysis because of the shortage of kidneys,” notes Yuman Fong, MD, Department of Surgery, City of Hope Medical Center, Duarte, California, in an accompanying commentary.
The findings from this British study “demand a re-examination of transplant using organs from patients with brain cancer,” he commented.
The modern imaging techniques used in the study means it is “highly likely that these staging techniques for ruling out metastatic disease contributed to the favorable outcomes,” Fong added.
Fong also raises the question of whether it would be possible to transplant cancer-free livers, as determined by assessing with, for example, circulating tumor DNA from cancer survivors to recipients with metastatic cancer isolated to the liver, or with liver failure from indolent cancers.
“It would be interesting to pursue a registry or protocol study using organs from patients with cancer when no suitable cadaveric or live donor is available,” he writes.
Cancer Usually a Contraindication to Donation
All organ transplants carry a small risk for disease transmission from the donor to the recipient, and an active malignancy is “usually a contraindication to organ donation,” say the researchers.
However, “the use of organs from patients with primary brain tumors is generally accepted because these cancers rarely spread beyond the central nervous system,” they add. So, the risk for cancer transmission is presumed to be lower than for other tumors, in addition to which, patients with brain cancer tend to be young and otherwise healthy.
Nevertheless, current evidence around whether organ transplant from donors with brain tumors is safe is inconsistent, and “opinions vary,” the researchers note.
To collect new evidence, the authors analyzed data on 13,274 solid organ donors in England and Scotland and found that 282 (2%) were from individuals with primary brain tumors. This amounted to 1014 organs donated to 887 recipients; of these, 778 (88%) were in the study population.
A total of 262 transplants (34%) were from donors with high-grade tumors, including 142 from patients with grade 4 tumors. In addition, 490 (63%) transplants came from donors who had undergone prior neurosurgical interventions or radiotherapy.
Compared with other donors, these individuals with brain tumors were younger, had fewer comorbidities and lifestyle risk factors, and had more favorable organ risk markers.
Over a median of 6 years, 83 posttransplant malignancies (excluding nonmelanoma skin cancer) occurred in 79 recipients of organs that came from donors with brain tumors. “No recipient tumors had a histological type matching that of the donor brain tumor,” the authors note.
The median age of the transplant recipients was 48 years, and 61% were male. The 10-year survival of transplants from donors with brain tumors was 65% for single kidney transplants, 69% for liver transplants, 73% for heart transplants, and 46% for lung transplants, which was similar to that for matched controls.
The findings show “that donors with brain tumors were a source of good-quality organs, as evidenced by favorable risk markers and excellent transplant outcomes,” the authors comment, “despite many donors having high-grade tumors or undergoing prior surgical intervention, both of which are considered as increasing the risk of transmission.”
Although there “may have been an aversion by transplant clinicians or their patients to use some organs from donors with high-grade brain tumors,” they believe that, taken together, these results “suggest that it may be possible to expand organ usage from donors with primary brain tumors without negatively impacting outcomes.”
The study was supported in part by a grant from the National Institute for Health and Care Research Blood and Transplant Research Unit in Organ Donation and Transplantation; a partnership between National Health Service Blood and Transplant, the University of Cambridge, and Newcastle University; a grant from the National Institute for Health and Care Research Cambridge Biomedical Research Centre; and PhD studentships from NHS Blood and Transplant.
Watson reports no relevant financial relationships. Other authors declare relationships outside of the submitted work. The full list can be found with the original article.
JAMA Surg. Published online March 22, 2023. Abstract, Editorial
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