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Thursday, July 2, 1998 Published at 23:04 GMT 00:04 UK


Fatal cancer passed on by organ transplant

The liver recipient died five months after transplant surgery

Serious doubts have been raised about transplanting organs from from cancer sufferers after a recipient contracted the disease following a liver donation.

But doctors are reluctant to change current policies because organs are in such short supply.

The 29-year-old recipient died from widespread cancer five months after the operation involving a donor who had undergone surgery to remove a brain tumour.

Experts were able to match the cancer in the transplant patient to the donor's disease.

In Britain and other European Union countries, as well as the United States, people with a history of malignant cancer are not normally accepted as organ donors.

Brain tumours are exception

But primary malignant brain tumours are an exception to the rule, because they only very rarely spread to other parts of the body.

The case, from Germany, reported in Friday's Lancet medical journal, proved that it is possible for cancer originating in the brain to spread to an organ used in a transplant operation.

About 900 transplants take place in Britain each year and up to 50 of these might involve donors who have died from a brain tumour.

The liver donor was a 47-year-old woman who died four months after having a brain tumour removed. A week before her death, she had undergone a second operation to take out a recurrent tumour.

Her liver and both kidneys were donated. The two patients who received the kidneys were doing well, with no signs of cancer 52 months after their transplants.

Fingerprinting techniques

[ image: The donor died of a brain tumour]
The donor died of a brain tumour
Dr Stephen Frank and colleagues, from the Technical University of Dresden, used DNA fingerprinting techniques to prove the liver recipient's cancer originated from the donor's brain tumour.

The doctors said that, ideally, patients with malignant brain tumours should be rejected as potential organ donors.

But they acknowledged: "Imbalances between the demand for donor organs and their availability necessitates running the small risk of donor transmission.

"At present the precise risk of this complication is unknown."

A spokeswoman for the UK Transplant Co-ordinators' Association, which is responsible for vetting donors, said that although there were broad guidelines every case was considered on its merits.

Potential donors who had died from brain tumours were always considered very carefully. Biopsy tests were conducted to make absolutely sure the tumour was a primary cancer which had started in the brain and not spread there from another part of the body.

Very small risk

The spokeswoman stressed that if there was a risk it was very small.

"A recipient might be willing to take that risk as long as it is explained," she said. "In a way I think it should be up to the recipient who takes that decision rather than the clinician."

She said there were currently 6,000 people waiting for organ transplants in the UK, most of them needing kidneys.

"The waiting list continues to grow and donation remains static. Only about 1% of people who died in hospital were suitable candidates for organ donation," she added.

'Cause for concern'

Dr Patrick Healey and Dr Connie Davis, from the University of Washington, Seattle, in the USA, wrote in The Lancet that the case was a "cause for concern."

They said: "Today's report justifies caution with and further investigation of the use of patients with brain tumours as organ donors."

But they said current policies should not be changed without more data.

"There are too few organs for transplantation for 1% of the liver-donor pool, as well as 1% of the total organ-donor pool, to be dispensed with," they said.

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