*Purpose: Donor derived malignancy is a contraindication for kidney transplantation. Published literature is devoid of instances of utilization of organs from donors with high PSA levels with a possibility of prostate cancer.

*Methods: We present a review of 2 kidney transplants performed from a single donor with an elevated PSA and an enlarged prostate gland on computed tomography of the abdomen.

*Results: The donor was a 56-year-old male with a KDPI score of 66% involved in a motor vehicle accident. The donor creatinine was 1.0 mg/dL, . Imaging demonstrated an enlarged, hemorrhagic and possibly necrotic prostate gland without any evidence of intra-abdominal trauma. A PSA level was assessed twice and reported at 191 and 220 ng/ml respectively. (Normal range 0-4.0 ng/ml). The kidneys were declined nationally prior to a planned DCD organ recovery. Our center proceeded with organ recovery for possible transplantation. The warm ischemic time was 20 minutes. The prostate gland was recovered during the organ recovery and multiple biopsies taken from the prostate gland. There was no evidence of gross or microscopic tumor, though multiple hemorrhagic areas were noted along with edema on frozen sections The kidney biopsy was unremarkable. After consultation with three urologists and the on-site pathologist a decision was made to transplant both kidneys into 2 female recipients. The patients had been on dialysis for 2 and 3 years, were both 65 years old with an EPTS of 64, 68 and CPRA of 37 and 88% respectively . The cold ischemic times were 12 and 20 hours respectively. Both kidneys suffered from delayed graft function. They received Thymoglobulin induction, Prednisone, Mycophenolate and Tacrolimus post operatively. There was focal nodular proliferation consistent with benign prostatic hypertrophy on the final report obtained two days after transplantation. After a year and 3 months, the creatinine is 1.04mg/dl (Gfr 57ml/min) , 1.54mg/dl (Gfr 34ml/min) and PSA not detected in either recipient at one year. Follow up renal transplant ultrasounds were negative for evidence of an intrarenal mass. In a physically traumatized donor , an isolated elevation of PSA with an enlarged prostate gland on imaging with no other evidence of abdominal or pelvic trauma, is highly suspicious for cancer. Frozen sections may not definitively rule out malignancy. Our experience suggests prostatic trauma may be independent of visible pelvic trauma, or a consequence of aggressive resuscitation in a trauma victim with pre-existing prostatic hypertrophy. Risk mitigation was employed by placing the kidneys in female recipient’s assuming the lack of testosterone would prevent any potential malignant cells from developing. PSA levels exceeding 100ng/ml are unlikely to be related to metastatic prostate cancer.

*Conclusions: Isolated elevation of PSA levels in a male deceased donor does not necessarily preclude organ donation.

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