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Transmission of cancer by a single multiorgan donor to 4 transplant recipients

• anonymfus 8y ago
  A mirror of the article's PDF: https://docdro.id/2T39U2W https://docdro.id/2T39U2W
• mataug 8y ago
  I'm not too surprised by the fact that cancer is transmittable via organ donation. I'm just surprised that the donor wasn't screened for probability of cancer using a DNA test. Or is that not possible ?
  • asdfasgasdgasdg 8y ago
    > The diagnosis of breast cancer was occult at the time of donation. I.e. they didn't find evidence of it at the time of donation.
    • mataug 8y ago
      So would it be valid to say that all transplant recipients have a significantly higher risk of developing cancer ?
      • deleted 8y ago
        [deleted]
      • Scaevolus 8y ago
        Yes, but it's largely because of the lifelong immunosuppression to not reject the transplant reducing the body's ability to combat cancer. Of course, it's still better than not having that organ! https://www.cancer.gov/about-cancer/causes-prevention/risk/immunosuppression https://www.cancer.gov/about-cancer/causes-prevention/risk/i...
        • mhalle 8y ago
          In addition, different organs need different amounts of immunosuppression. Livers are used to filtering random things and thus the body is more tolerant of livers (needs less immunosuppression). Some older liver transplant recipients can actually drop their immunosuppression drugs completely. The exact transplant protocol also influences long-term levels of immunosuppression and thus cancer risk.
      • saudioger 8y ago
        Well sure, more risk than an individual, less risk than two individuals.
      • throwaway76543 8y ago
        Yes, but not just from the transplant. The immunosuppressant drugs following a transplant also increase your risk of cancer. Dramatically for certain types of cancers.
  • btilly 8y ago
    That is not possible. What presumably happened is that there was an undetected early cancer. That left circulating tumor cells throughout a body otherwise filled with healthy tissues. Unless you find those specific cells, there will be no sign of a problem. (At least not until they find a home and start a new cancer.) See https://en.wikipedia.org/wiki/Circulating_tumor_cell https://en.wikipedia.org/wiki/Circulating_tumor_cell for more.
    • matthewrudy 8y ago
      I'm surprised about this. I get that there can be circulating cells, but the probability of them successfully metastasising in the early stages is very low. Normally it's only later stage cancers that end up spreading. I guess it's down to the immunosuppression making metastasis more viable.
      • btilly 8y ago
        If it wasn't a surprising situation, it wouldn't have been in a medical journal. However its possibility isn't crazy. Per https://www.ncbi.nlm.nih.gov/pmc/articles/PMC22534/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC22534/ it seems that cancer cells can be detected in the blood before the cancer itself is detectable by traditional means. Therefore an undiscovered cancer could well have left circulating cells in multiple organs.
      • throwaway234287 8y ago
        I'm not an expert, but my understanding is that the probability or rate (or expected time) of metastasizing varies a lot depending on the type of the tumor. (I looked into this a bit when I was diagnosed; it was more or less likely to metastasize within a somewhat short time, depending on the exact type of the tumor.) I'm sure the immunosuppressants needed after a transplant would increase the risk in any case.
• _rpd 8y ago
  Donated her kidneys, lungs, liver and heart. All four recipients developed a similar breast cancer.
  • anonymfus 8y ago
    Heart recipient died from sepsis before developing cancer. There were two kidney recipients, right kidney recipient remains alive because of nephrectomy.
• delbel 8y ago
  probably a parasite
• pkaye 8y ago
  I'm on a kidney transplant list myself. I'm already aware there is a higher risk of cancer than the average population. But one had to live with the cards dealt in life so I have to accept that risk. I'm also hoping for the success of the UCSF artificial kidney. They are in early stage testing in humans. https://pharm.ucsf.edu/kidney https://pharm.ucsf.edu/kidney I think if you read up on it, there is a lot of opportunities for budding young bioengineers and material scientists to help improve on this technology. They build a precision pore size filter and coat it with human cells.
  • Waterluvian 8y ago
    Reminds me of chemotherapy and countless other medical procedures. We do the best with what we've got. It's not like we're going to collectively say, "not going to do anything until we've come up with the perfect solution to this ailment." To an extent, I try to keep this in mind when arguing with the engineering devil on my shoulder that constantly shouts, "no, you have to do it right!" I imagine your prognosis without a transplanted kidney is markedly worse.
    • pkaye 8y ago
      I met up with a transplant patient at a seminar for candidates. Her kidneys were going bad 20 years ago but it was manageable. She ended up getting leukemia 10 years ago and went through the chemo. Then 5 years ago she got diabetes around the time she had to start dialysis. Then 2 years ago when she was about to get a transplant, they found out she had some heart issues due to the chemo treatment and needed some surgery. She finally got the kidney transplant beating all odds and now looks in great shape looking 10 years younger. I was greatly inspired by her journey. Its possible to live reasonably long with dialysis if you don't have other health issues but yeah a kidney transplant is a lot better.
      • Ntrails 8y ago
        HaemoDialysis is miserable. You feel shit ~5 days out of 7, it's exhausting and depressing and it never gets better. Transplant is infinitely preferable if it's an option. CAPD is arguably less miserable as a dialysis option but the day to day lifestyle is not exactly ideal
• gammateam 8y ago
  wouldn't this help narrow down the series of events and influences to cause these cellular errors?
• hooloovoo_zoo 8y ago
  It's interesting to me that the survivor required chemotherapy in addition to removing the immune system suppressants. Perhaps the immune system evading strategies of tumors can be exploited in future transplant operations?
  • killjoywashere 8y ago
    > the survivor required chemotherapy in addition to removing the immune system suppressants Ah ... probably they took a "belt and suspenders" approach.
• maxander 8y ago
  If that wasn’t surprising enough for you- there’s a cancer line that has been propagated between dogs for centuries: https://en.m.wikipedia.org/wiki/Canine_transmissible_venereal_tumor https://en.m.wikipedia.org/wiki/Canine_transmissible_venerea...
• killjoywashere 8y ago
  Now, imagine a blood donor with occult disease... To my knowledge a case of carcinoma (epithelial cell origin) transmitted via blood donation has not been recorded yet, however, hematologic maligancies are theoretically very possible.
• byteCoder 8y ago
  As a melanoma survivor, I'm no longer eligible to be an organ donor. In fact, I could even donate blood until the American Red Cross changed their guidelines for eligibility in 2017: Benign cancer or tumor: Acceptable to donate Basal cell carcinoma: Deferred for four weeks after date of surgical removal Squamous cell carcinoma (skin, cervix, or oral cavity): Deferred for four weeks after date of surgical removal Malignant cancer (e.g., breast, prostate, or colon cancer and melanoma): Deferred for one year after treatment is completed Leukemia, Hodgkin’s and non-Hodgkin’s lymphoma, and myeloma: Ineligible to donate permanently Kaposi’s sarcoma: Ineligible to donate permanently
  • tamcap 8y ago
    Also, for blood at least: 5 years (cumulative) in Europe: Ineligible to donate permanently Which drives me nuts...
    • jimmy1 8y ago
      Don't donate to the Red Cross anyways. I was a long time donor and I recently told them off when I actually took the time to read the packets and disclosures and it turns out they ship your blood off to universities for testing and research -- with or without your consent, which I object to on principle alone, but also there is now a moral unknown for me if my blood is going towards research I morally object to. Again, maybe not most people's here problem with it, but on principle I do not like not being in control of what is done with own blood (I want it to go help people, not be test subjects), and probably most people here can at least agree with that. Also, they sell your blood to hospitals at a hefty markup. Donate directly to the hospitals -- most if you walk in and say you are there to donate blood will happily accept you. Second best is probably a community blood center.
      • sokoloff 8y ago
        I accept your view as your own, but I personally believe that research at universities is helping people, just indirectly and with a time shift and a level of uncertainty.
• DoreenMichele 8y ago
  I just wish outcomes like this were stronger motivation for the world to work harder on other solutions. But it never seems to go that direction. Instead, it spurs discussion of finding ways to improve transplants.
  • mhalle 8y ago
    That's because transplants save thousands of lives every year, rapidly turning some of the sickest people this side of death into healthy, productive, living individuals. As a liver transplant survivor, it's hard to describe how dramatic a cure transplant represents. Of course, there is a great price: my life in exchange for the donor's. And so many people are listed for transplant who never receive an organ. Those facts and the threat of disease, among many others, drive the research into alternatives (xenotransplantation, synthesized organs, etc). But transplant is currently the only hope for the desperately hopeless facing organ failure.
    • DoreenMichele 8y ago
      None of that is actually a rebuttal.
      • dylan604 8y ago
        What kind of rebuttal are you looking for? Transplant surgery saves lives now. Any new method is an unknown time away. Is the world supposed to stop saving lives with the known working method with all of its pros and cons in order to spend that money developing something that may or may not ever happen? From where I see it, trying to improve upon an existing method so the success rate/viability after the procedure increases is not a wasted effort. It's kind of like refactoring code that already works. You plow through it to get to work originally, then you go back and keep tweaking it until it no longer crashes or has bugs and works as efficiently as possible.
        • DoreenMichele 8y ago
          I'm not looking for a rebuttal at all. I don't see why the sentiment needs to be decried, shot down and downvoted. Why is it such a crime to wish for more research into other approaches? That sentiment in no way suggests any of the ugly things you are taking it to mean.
• caymanjim 8y ago
  I had lymphoma, which is categorized as a blood cancer. As a result, I'm not allowed to donate blood (ever again) or organs. The thing is, I'm almost certain that this isn't recorded anywhere. Not that I want it being recorded (on principle for privacy rights; I don't actually care), but I'm pretty sure I could donate both blood and (I hope never to be in this situation) organs, and no one would be any the wiser.
• mhalle 8y ago
  The opposite problem is a compelling one as well. My transplant surgeon says that "Snow White isn't going to be your organ donor", meaning that patients must understand that every organ will have flaws and exposure to disease, exposure to imperfect lifestyles, etc. None are perfect. But transplant recipients don't need a perfect organ. They just need one that will get them through their natural life. A "good enough" one. This mindset is important for the moment when an organ becomes available. Many patients on the wait list for organs actually turn down donor offers because of some imperfection the doctor told them about. In fact, some people turn down an organ just because another patient previously turned it down - even though the reason might have nothing to do with the viability of the organ itself. The consequences of such a decision can be fatal. Instead, my surgeon pioneered the idea of transplanting Hepatitis C infected livers into patients who needed transplant because of HepC-driven liver failure. His idea was that young people recently infected with HepC who die tragically are often in otherwise excellent health (HepC is a slowly progressing disease) and make good donors. His work allowed him to clear out the backlog of patients awaiting liver transplant at his center, with success rates as good as any other hospital. And today, it's possible to kill HepC with anti-viral agents post-transplant. (Minor edit for clarity.)
  • Laforet 8y ago
    This is interesting but very, very ahead of its time. I know a couple of surgeons who have done a lot of research to prove that liver with a moderate degree of steatosis (fatty liver) is still viable as grafts, because every now and then they have had to cancel a scheduled transplant because the donor liver turned out to be more fatty than the standards would allow. They are optimistic but it would still take anywhere between 5-20 years for enough evidence to accumulate and change the view of regulators.
  • candiodari 8y ago
    There are many problems with organ donation. From moral problems with collecting organs (esp. in specific political environments, but even in the west, questions arise where doctors are paid for organs. Even when unpaid, delivering organs is very good for doctor's careers, which raises questions about decision making). And on the receiving end there's also serious moral and practical questions. Should this organ go to A or B ? Both will die if they don't get it. It must suck badly to answer that question even if we have clearly advanced over the years. There's other issues, like what is the reward for the organ donor ? Can we allow (some) rewards ? There's also big differences in the different possible procedures. Liver transplant and bone marrow transplant ... are merely painful for the donor. They don't result in the loss of an organ. Should we allow for compatible donor search and allow communication in these cases ? (granted, while a liver transplant is essentially a big needle in your abdomen for ~40 seconds with no ill effects, bone marrow transplant is ... very painful, even afterwards, so there's only so much sedation helps). I'd say yes. Others are resulting in the loss of a mostly redundant organ, like kidney or lung transplants, and then there's the transplants of organs that will result in the death of the donor, like heart or pancreas transplants. It will be a very good day where we can just grow organs from a patients own cells, because they will solve essentially all the above problems, as well as eliminate most, almost all, quality problems with organs.
• andy_ppp 8y ago
  It probably doesn’t help that the same drugs that stop you rejecting organs hammer your immune system and weaken it’s surveillance for foreign entities.
• frenchman_in_ny 8y ago
  Cancer is a risk of long-term use of immunosuppressants in transplant populations as well[0]. [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2865745/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2865745/