Are there any organs that cannot be donated?

Organs and Tissues That Cannot Be Donated

While most organs and tissues can be donated under appropriate circumstances, certain organs are absolutely contraindicated for donation based on specific donor conditions, particularly active malignancy, uncontrolled infections, and certain high-risk tumors.

Absolute Contraindications Based on Donor Conditions

Malignancy-Related Exclusions

The following malignancies represent absolute contraindications to organ donation:

• Melanoma - Cannot be donated under any circumstances 1
• Choriocarcinoma - Absolute contraindication for all organ donation 1
• Lung cancer - Absolute contraindication for organ donation 1
• Glioblastoma multiforme (grade IV glioma) - Absolute contraindication, particularly when blood-brain barrier integrity is compromised through surgery, radiotherapy, or ventricular-systemic shunts 1
• Advanced colorectal cancer (>T3 stage) - Absolute contraindication 1
• Advanced breast cancer (>T1c stage) - Absolute contraindication 1

Infection-Related Exclusions

Organs cannot be donated from individuals with:

• HIV-1 or HIV-2 infection - Absolute contraindication despite treatment advances 1
• Active systemic infections with multidrug-resistant organisms without therapeutic options 1
• West Nile virus infection of the central nervous system - Donors should not be considered eligible 1
• Clinical encephalitis without proven cause - Should be avoided due to viral transmission risk 1
• Trypanosoma brucei (sleeping sickness) - Organs should be rejected due to severe prognosis and treatment toxicity 1

Conditional Exclusions

Brain Tumors with Specific Criteria

• High-grade central nervous system tumors where blood-brain barrier integrity is compromised are contraindicated 1
• Low-grade primary intracranial malignancies may be acceptable with careful evaluation, though small transmission risk remains 1

Active Malignancy

• Donors with active malignancy should generally be excluded, though some cases with low transmission risk, clear management plans, and minimal donor risk may be considered on a case-by-case basis 1

Important Caveats

The decision framework prioritizes recipient safety over organ availability, though individual risk-benefit analysis is essential:

• Recipients must be counseled about transmission risks when considering organs from donors with treated malignancies or certain infections 1
• The risk of dying on the transplant waiting list must be weighed against potential transmission risks 1
• Some organs may be acceptable for life-saving transplantation (e.g., heart) from questionable donors but not for life-enhancing procedures 1

Screening Requirements

All potential donors require comprehensive screening:

• Cancer screening consistent with regional clinical practice guidelines must be current at time of donation 1
• Infectious disease screening for HIV, hepatitis B and C should be performed within 28 days of donation 1
• Thorough examination of thoracic and abdominal cavities for metastatic disease must occur during organ retrieval 1

The fundamental principle remains that organs from donors with the specific malignancies and infections listed above represent unacceptable risks for transmission and should not be used for transplantation.