In Spain there have been six deaths from similar cases since 1996.
The magazine The Transplant Society of the United States has published the work of several doctors from the Netherlands and Germany in which they expose a rare case of cancer transmission through organ donation. Four patients suffered from this disease and three of them died after receiving transplants from a 53-year-old woman who died of a cerebral infarction in the Netherlands in 2007 and in which the disease had not been detected. The donor underwent routine medical check-ups after her death and no tumor marker was detected, so her kidneys, lungs, liver and heart were removed.
The first recipient affected was a 42-year-old woman who had received both lungs and was diagnosed with breast cancer with metastases in other organs, only 16 months after the operation. The DNA analysis determined that the tumor cells that killed the woman came from the donor, so the organization Eurotrasplant alerted the case in January 2010.
The recipient of the left kidney also died of the disease in 2013. Shortly after, in 2014, the woman transplanted with the liver of the donor died. This was alerted to the presence of the breast tumor in 2011, but refused to have the organ removed.
A 32-year-old man, a recipient of another kidney, was also alerted to the situation. In this case, the organ was removed, successfully treated against cancer and still alive.
In all patients, DNA markers were detected in the tumor cells that coincided with the genetic profile of the donor. The recipient of the patient’s heart died five months after the operation because of an infection.
“This is the first case of transmission of breast cancer as a result of a transplant of organs from a single patient affecting four recipients”, highlight those responsible for the work, led by Frederike Bemelman, specialist in kidney transplants University Medical Center of Amsterdam. “No previous study had detected such a long interval between the transplant and the manifestation of the tumor,” highlights the published work.
The patient suffered “micrometastases” in each of the donated organs that went unnoticed at the medical check-ups, according to the study. People who receive a transplanted organ receive drugs that suppress their immune system to prevent rejection. This fact favored that the tumor cells expanded more easily and caused metastasis in the receptors.
These cases do not imply a failure of the transplant system or the medical controls, both the authors of the study and the independent experts consulted stand out. And changing them in the light of these data would be a mistake, because if more detailed controls are made, false positives would increase and healthy organs would be lost for donation. “In transplants there is never a zero risk and patients are always warned about it,” says Elisabeth Coll, director of Medical Services of the National Transplant Organization.
In global terms, these cases occur only in five out of 10,000 transplants. In Spain, 10 patients have suffered a cancer associated with a transplant and six of them died from the disease between 1996 and 2006, the last year with published data, according to the NTO. “These are unfortunate cases that we can and must learn in order to reduce the risk to the maximum, I think it is important that the risk of transmission is already extremely low and that a risk-benefit ratio is always made in an individualized way when doing a transplant “, highlights Coll. Between the years a total of 38,215 transplants were performed in the country.
Spain follows the protocols of the Council of Europe in terms of medical checks on organ donation. This includes a “detailed” analysis, says Coll, of the clinical history of each donor, a blood test to know the status of all organs, an abdominal ultrasound and a chest x-ray. These methods are capable of detecting tumors “of a few millimeters”, highlights Coll, the problem he says “is that there are undetectable microscopic neoplasms” that are the ones that explain the rare cases detected so far. “These cases are something totally extraordinary, at the same time it is a necessary risk that has to be taken because otherwise people would die for not receiving a transplant.
