Can an elderly patient with metastatic cancer donate organs or tissues?

Organ and Tissue Donation in Elderly Patients with Metastatic Cancer

Elderly patients with metastatic cancer are absolutely contraindicated from donating organs or tissues due to the high risk of cancer transmission to immunosuppressed recipients, which is often fatal. 1

Absolute Contraindications for Donation

Metastatic Cancer as a Disqualifying Factor

• Any evidence of metastatic disease completely excludes a potential donor from organ or tissue donation. 1
• Transmission of donor-related malignancy through organ transplantation is often a fatal complication in immunosuppressed transplant recipients. 1
• At the time of organ retrieval, a thorough examination of the thoracic and abdominal cavities for metastatic tumor must be undertaken, and any evidence of metastasis disqualifies the donor. 1

Specific Cancer Types with Absolute Contraindications

The following malignancies constitute absolute contraindications to organ donation regardless of stage or treatment history:

• Melanoma - even with remote history (one donor with melanoma 32 years prior transmitted fatal disease). 1, 2
• Choriocarcinoma 1
• Lung cancer 1
• Glioblastoma multiforme (high-grade CNS tumors, especially with compromised blood-brain barrier). 1

Advanced Stage Common Cancers

• Colorectal cancer >T3 stage is an absolute contraindication to donation. 1
• Breast cancer >T1c stage is an absolute contraindication to donation. 1
• Ovarian cancer has been transmitted from donor to recipient and generally presents in advanced stages with high recurrence rates, making donation extremely high risk. 1

Why Metastatic Cancer Precludes Donation

Risk of Transmission

• Approximately 43% of recipients who received organs from donors with known malignancies developed transmitted cancers. 3
• Of 270 recipients from donors with malignancies, 117 (43%) had evidence of transmitted cancers, with 66 patients developing distant metastases. 3
• One donor with glioblastoma multiforme transmitted fatal tumors to three recipients. 2
• Cancer transmission through organ transplantation has been documented with various malignancies, and genetic analysis can confirm donor origin of the cancer. 4

Immunosuppression Amplifies Risk

• Transplant recipients require lifelong immunosuppression, which dramatically increases the risk that any transmitted cancer cells will proliferate unchecked. 1
• The immunocompromised state of recipients makes even low-grade or microscopic malignancies potentially lethal. 1

Special Considerations for Age

Advanced age alone does not preclude donation, but it significantly increases the likelihood of undiagnosed malignancies. 5

• Use of older donors is accompanied by the likelihood that a significant proportion may have undiagnosed malignancies. 5
• Extended criteria donors (age >65) may be considered for specific recipients, but this applies only to donors without any history of malignancy. 1
• The combination of advanced age AND metastatic cancer creates an unacceptable risk profile. 5

Limited Exceptions (Not Applicable to Metastatic Disease)

The following scenarios represent the only contexts where donors with cancer history might be considered, and none apply to metastatic disease:

Very Low-Risk Cancers Only

• Non-melanoma skin cancer (basal cell or squamous cell carcinoma) may be acceptable after complete excision. 2
• Low-grade primary CNS malignancies without blood-brain barrier compromise and without shunt placement may be considered in select cases. 1, 6
• Carcinoma in situ of the uterine cervix after adequate treatment and disease-free interval. 2

Required Disease-Free Intervals for Non-Metastatic Disease

Even for potentially acceptable cancers (which excludes metastatic disease), strict criteria apply:

• Minimum 2-year disease-free interval for low-risk gynecologic cancers (uterine corpus). 1
• 2-5 year disease-free interval for invasive cervical cancers. 1
• Consultation with oncology specialists required to assess recurrence risk based on tumor histology, stage, and treatment. 1

Critical Pitfalls to Avoid

Nontraumatic Cerebral Hemorrhage

• Donors with past cancer history who present with nontraumatic cerebral hemorrhage raise particular concern, as this may result from unrecognized metastatic tumor. 2
• This scenario requires extreme caution and typically excludes donation. 2

Inadequate Donor Screening

• The risk of donor-transmitted cancer is very low in properly screened donors (<0.03% in UK series), but cannot be completely abolished. 6
• Meticulous preoperative screening, careful examination of all organs at harvesting, biopsy of suspicious lesions, and routine donor autopsy are essential. 3
• Failure to identify metastatic disease at procurement can result in fatal outcomes for multiple recipients. 2, 3

Definitive Answer for Your Patient

An elderly patient with metastatic cancer cannot donate organs or tissues under any circumstances. 1 The presence of metastatic disease represents an absolute contraindication due to the unacceptably high risk of transmitting fatal malignancy to immunosuppressed recipients. 1, 3 This prohibition applies regardless of the primary cancer type, treatment history, or the patient's age. 1