Cancer Transmission in Deceased Donor Organ Transplantation: An Australian Population‐Based Linkage Study of Donor Referral Data

BACKGROUND: Cancer transmission risks from deceased organ donors to recipients may be overestimated, and there is often hesitancy in accepting potential donors with a history of cancer, regardless of absolute risk. We linked all persons referred for consideration for deceased organ donation (actual donors and potential donors forgone) and transplant recipients, 2010-2018, with the population cancer registry, 1976-2018, in NSW, Australia. We sought to estimate the transmission risk for common cancers (breast, prostate, colorectal) in deceased donors and identify missed opportunities for donation. METHODS: Firstly, cancer transmission rates from actual donors were assessed. We then compared suspected cancer history during medical assessment with the cancer registry for those potential donors forgone. RESULTS: There were 165 cancer histories verified in 993 deceased donors, with one high-risk breast, six minimal-to-high-risk prostate, and no colorectal cancers. Organs from these seven donors were transplanted in 11 recipients (10 kidneys, 1 liver) with no evidence of 'Proven/Probable' cancer transmission after a median 6-years' follow-up. Additionally, 169/3588 (5%) potential donors were forgone for a suspected Common Cancer transmission risk. Of these, 6/169 (4%) had no cancer verified, and 39/169 (23%) had a verified cancer that was of minimal-to-low risk for transmission. Accepting these 45 additional donors would have increased donation rates by 5%. CONCLUSION: A balanced review of transmission and non-transmission events in organ donation, along with improved decision support, could inform current risk assessments and improve donation rates.