NEW YORK, Jul 06 (Reuters) -- Since brain malignancies seldom spread to other parts of the body, most experts agree that the organs of patients who died due to a brain tumor can be safely donated to patients in need.
However, a report in this week's issue of The Lancet describes a case of fatal brain tumor, apparently transmitted from donor to recipient through liver transplant.
The report "justifies caution with and further investigation of the use of patients with brain tumors as organ donors," conclude Drs. Patrick Healey and Connie Davis of the University of Washington Medical Center in Seattle.
Their commentary accompanies a report by researchers at the Technical University of Dresden, in Germany.
The German team report the case of a 47-year-old liver donor who died after developing glioblastoma multiforme, an incurable, lethal form of brain tumor. An autopsy performed soon after the patient's death revealed no apparent sign of cancer spread.
The patient's liver was subsequently transplanted into the body of a 29-year-old recipient. The researchers say the recipient developed cancers at various sites (including the brain) soon after the transplant, and died about 5 months later.
After conducting DNA and laboratory testing, the investigators concluded that all of the recipient's cancers were "donor-related."
In their editorial, Healey and Davis note that about 1% of all transplanted organs originate in donors who have succumbed to some form of brain tumor. They explain that since only a very small minority of all brain tumors ever spread to other body areas, "the policy of the United Network for Organ Sharing (UNOS) in the USA is that...(most types of) brain tumours are acceptable in an organ donor."
Healey and Davis believe the possibility of a small risk of transplant-related cancers must be weighed against the fact that nearly 1,000 patients die each year while waiting for transplant. "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," the Seattle authors conclude.
They suggest that livers procured from deceased brain cancer patients be offered first to "those (individuals) who would die without an immediate transplant."
Responding to the issue, UNOS has recently set up a special computerized database aimed at tracking cancer incidence (and therefore, risk) among US organ recipients. SOURCE: The Lancet 1998;352:2-3, 31.
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