Transplantation of organs from deceased donors with brain cancer appears relatively safe and may be a strategy to expand the donor pool, according to British investigators.
George H. B. Greenhall, MBChB, of NHS Blood and Transplant in Bristol, UK, and colleagues used 3 UK transplant and cancer registries to identify 282 deceased organ donors (median age 42 years) with primary brain tumors. These individuals donated 1014 organs to 887 recipients. Among transplants, 262 involved donors with high-grade brain tumors and 494 involved donors with prior neurosurgical intervention or radiation therapy.
Over a median 6 years, 83 posttransplant malignancies (excluding nonmelanoma skin cancer) occurred in 79 recipients of organs from donors with brain tumors – but there were no cases of brain cancer transmission, Dr Greenhall’s team reported in JAMA Surgery.
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“Although active malignancy is usually a contraindication to organ donation, the use of organs from patients with primary brain tumors is generally accepted because these cancers rarely spread beyond the central nervous system,” the investigators wrote.
At 10 years, transplant survival was 65% for kidneys, 69% for livers, 73% for hearts, and 46% for lungs harvested from donors with brain cancer.
The investigators found comparable organ utilization rates between organ donors with and without low-grade brain cancer. For donors with high-grade brain cancer, the odds of kidney, liver, and lung transplantation were decreased by approximately half.
“Taken together, these observations suggest that it may be possible to expand organ usage from donors with primary brain tumors without negatively impacting outcomes,” Dr Greenhall’s team wrote. “Although this is likely to result in a modest increase in the number of transplants in the UK, our findings may be particularly relevant to countries with more conservative guidelines, including the US.”
In an accompanying editorial, Yuman Fong, MD, of City of Hope in Los Angeles, California, commented that the study findings “demand a reexamination of transplant using organs from patients with brain cancer.” He noted that improvements in imaging for solid cancer staging help rule out metastasis.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
References
Greenhall GHB, Rous BA, Robb ML, et al. Organ transplants from deceased donors with primary brain tumors and risk of cancer transmission. JAMA Surg. Published online March 22, 2023. doi:10.1001/jamasurg.2022.8419
Fong Y. Expanding the donor pool for organ transplant using organs from donors with cancer. JAMA Surg. Published online March 22, 2023. doi:10.1001/jamasurg.2022.8427
