Cancer transmission from organ donors is a rare complication of transplantation. While some cancer histories in donors are classed as unacceptable or high risk because of their perceived risk of transmission to the recipient, potential recipients endure significant risk of death whilst awaiting transplantation. We studied our donor cohort with regards to their cancer history and its impact on their recipients including recipient survival and any evidence of cancer transmission.

Data for donors and recipients (1990-2008) were obtained from the National Transplant Registry and Cancer Registries. For donors with a history of cancer, guidelines from the Council of Europe and United Network for Organ Sharing were used for classification of cancer transmission risk.

Of the 17639 donors, 202 (1.15%) had a history of cancer. There was no significant difference in survival of single organ recipients (p = 0.28) from donors with or without a history of cancer: 7.7 years (95% CI 5.4,-) and 8.6 years (95% CI 8.3, 8.8). Cancers classed as unacceptable or high risk of transmission were noted in 61 donors including cancer of breast (10), melanoma (3), lymphoma (5), colon (3), ovary (2), sarcoma (4) and tumours of central nervous system (34). None of these cancers was transmitted to their 133 recipients. At 10 years from transplantation, recipients from unacceptable or high risk donors survived for 1148 life-years (95%CI 1027, 1269) with average survival of 8.6 years (95%CI 7.7, 9.5) per recipient.

Annual mortality rates among patients awaiting transplantation are high (5 to 15%) whereas the risk of cancer transmission, even from 'high-risk' donors appears to be very low. Among donors with non-CNS cancers, a selected sub-group of donors classed as unacceptable or high risk of cancer transmission can be a safe and valuable source of additional organs. Organs from donors with a history of superficial spreading type of melanoma, hormone receptor negative breast cancer, right sided colon cancer (cancer-free for more than 5 years) or ovarian cancer (cancer-free for more than 10 years) can be considered for transplantation as, in our study, these cancers did not transmit. Careful donor risk assessment and informed consent can result in significant survival benefit with low cancer transmission risk.

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