Incidental Diagnosis of Cancer in Deceased Organ Donors
Objective: The number of elderly deceased organ donors is increasing. In 2003, 9% of U.S. donors were greater than 65 years old. We postulated that older donors would be more likely to harbor an occult carcinoma, discoverable at the time of organ procurement.
Design: Retrospective chart review.
Setting: UNOS Region 1 (New England) Organ Procurement Organizations.
Patients: Deceased organ donors 1997-2004.
Interventions: Exploration at recovery to detect occult malignancies.
Main Outcome Measures: Incidence of occult carcinoma, organ utilization and cancer transmission.
Results: During the study period 2841 kidneys were recovered and 430 (15.2 %) were discarded. Twenty-nine kidneys were discarded after discovering a renal mass (14 donors - 11 with renal cell carcinoma and 3 benign) or lung cancer (1 donor) at the time of procurement. There were 13 male donors and 2 female; 12 were Caucasian. Donors with malignancy ranged from 40-78 years old. Their average was 56.4 ± 10.7 years, compared to the age of donors who were free of cancer 40 ± 18 years (P=0.01). Seven organs (4 livers, one heart, pancreas and kidney) were transplanted from these donors and all other organs were discarded either due to organ unsuitability or the cancer diagnosis. No malignancy was transmitted to any of the organ recipients.
Conclusions: Older organ donors are more likely to harbor an undiagnosed malignancy. Interestingly, renal cell carcinomas, which account for less than 3 % of organ malignancies in the general population, accounted for 92 % of the incidental cancers in this series. Surgeons should conduct a careful search for malignancies during organ recovery.
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