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Donor transmission of malignancy is a rare but dreaded event as it can progress to metastatic disease in the recipient. The consequences of transmission of cancer are grave due to the recipient’s immunosuppressed status, which can cause rapid spread and even result in death within a short period. Due to the scarcity of organs for transplantation, deliberate use of organs from donors with a history of cancer has been explored. One of the biggest challenges that transplant clinicians face is the decision to transplant organs from a donor with an active or past history of malignant disease. The rate at which different cancers are transmitted vary, and careful selection strategies need to be implemented while assessing a donor with a history of malignancy. Various factors such as the type of tumor, histology, stage at initial diagnosis, disease-free interval, etc., should be considered when assessing donors with a history of malignancy.


Active malignancy is an absolute contraindication for living donation. But potential living donors with certain types of low-grade tumors that underwent curative treatment may be considered acceptable after careful evaluation. As cancer risk is strongly associated with age, most living donors provide a degree of protection from cancer due to their young age. Unknown transmission of malignancy from a living donor is rare and has been reported in one in every 5000 living donations. The first case reported was a breast cancer from a donor wife to her husband who was the recipient, but many common cancers like colon, prostate, cervix, etc., have been known to occur.

In some centers, donation may be considered where there is a small (<4 cm) subcapsular renal cell carcinoma with complete bench excision at the time of donor surgery and no distant spread.


Reported transmission rates are <0.03%, but are likely underreported and underdiagnosed. The most common transmitted cancer types are renal cancer, lung cancer, melanoma, and lymphoma. The risk of donor transmission depends on the type and extent of the original donor cancer.

In 2011, the Malignancy Subcommittee of the Disease Transmission Advisory Committee (DTAC) of the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) suggested risk categorizations for specific tumor types.

  • Prognosis of recipient with donor-derived malignancy is highly dependent on the cancer type.

  • Recipients with transmitted renal cancers have the best outcomes, with >70% 2-year survival posttransplantation.

  • Patients with melanoma and lung cancers have <50% 2-year survival posttransplantation.

  • Early donor-transmitted cancer (diagnosed <6 weeks of transplantation) has been associated with a better outcome compared with late donor-transmitted cancer.

  • Management options for donor-related cancers include reduction or cessation of immunosuppression, as well as conventional treatment approaches, such as surgical resection of the cancer and/or the graft, radiotherapy, and chemotherapy.

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