This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Cancer transmission from organ donors with brain tumours is unlikely, new research found. The findings suggest it may be safe to increase the use of organs from people who died of a brain tumour.
Cancer can be passed on from donor to recipient via organ transplants. Limited evidence suggests a very low risk of transmission from donors who died of brain tumours. The new analysis supports this suggestion. It found no cancer transmission in 778 recipients of organs from donors who had a tumour that started in the brain (primary brain tumour).
Researchers used data from registries in England and Scotland. The team found that transplant survival was similar, whether or not the organ donor had a brain tumour. Transplant survival meant the recipient was alive and had not needed another transplant nor, for kidneys, long-term dialysis (procedure to remove waste products and excess fluid from the blood).
Fewer kidneys, livers, and lungs were accepted from donors with fast-growing brain tumours (high-grade) than from donors without cancer. But acceptance of organs from donors with slow-growing (low-grade) brain tumours was similar to that from donors without cancer.
Clinicians could use these findings to counsel people about the risks and benefits of accepting an organ from a donor who died of a brain tumour.
More information on organ donation is available on the NHS website.
The issue: should I accept an organ from someone who had a brain tumour?
A shortage of organ donors means that 7000 people in the UK are waiting for a transplant. In 2022, 430 people died while on the waiting list. Others become too unwell to have the procedure while they wait.
Cancer can be passed on from donor to recipient via an organ transplant. However, cells from brain tumours are less able to spread around the body than cells from other cancers. The risk of cancer transmission is therefore lower than if donors have a different type of cancer.
Donors with brain tumours tend to be younger and healthier, with organs in better condition, than other donors. Greater use of organs from donors with brain tumours could benefit many people waiting for a transplant.
Clinicians have different opinions on the safety of transplants from donors with brain tumours. This uncertainty is reflected in the variation in guidance; guidelines are stricter in the US than in Europe. A better understanding of the risks and benefits would help clinicians counsel patients about accepting an organ from someone who died of a brain tumour.
In this study, researchers evaluated the risk of passing on cancer via an organ transplant from someone who had a brain tumour.
What’s new?
The study was based on data from transplant and cancer registries in England and Scotland. It included all donors with brain tumours between 2000 – 2016, and the 778 people who received one of their organs. Recipients were followed up in 2020.
The main outcomes were the number of times cancer was passed on from donor to recipient, and transplant survival. Donors with brain tumours were matched to other donors (by age, sex, and time of donation).
Among 778 recipients of organs from donors who died of brain tumours, the study found that:
- no cancer transmission occurred
- transplant survival was similar, whether or not donors had brain tumours.
Though 89 recipients developed cancer during follow-up (average 7 years), the researchers judged that these cancers had occurred naturally rather than being passed on from the donor. This is because the type of cancer was different from the donor’s. However, genetic analysis of these cancers was not carried out.
The researchers also measured the acceptance of organs. Among 378 potential donors with brain tumours:
- organs from donors with slow-growing tumours were as likely to be accepted as organs from matched donors
- kidneys, livers, and lungs from donors with fast-growing tumours were less likely to be accepted than from matched donors.
Why is this important?
This analysis found no evidence of cancer transmission to organ recipients, even from donors with fast-growing brain tumours. This suggests that the risk of cancer transmission via transplants from donors who died of brain tumours is lower than previously thought.
Organs from donors with brain tumours were adequate, and led to successful transplants. This suggests that organs from people with brain tumours, even fast-growing tumours, may be safely used.
The analysis suggests that clinicians or patients may be rejecting organs from donors with fast-growing brain tumours. If organs from people with fast-growing brain tumours had been accepted at a similar rate to that from matched controls, an additional 61 transplants would have been performed. The use of lungs was notably low, given that this group is at high risk of death while waiting for transplants.
What’s next?
Following this study, the Donor Organ Risk Assessment Committee is updating UK guidance on transplants from people who died of brain tumours.
The findings could help clinicians discuss the risks and benefits of accepting an organ from donors who died of brain tumours. Accepting more organs from this group of people could reduce the numbers waiting for a transplant. Any risk of cancer transmission needs to be balanced against the known risk of the person dying while waiting for a transplant, and the scarcity of suitable organs.
This study is part of a wider analysis of transplants from donors who have had other types of cancer. The researchers hope to be able to refine national guidelines.
You may be interested to read
This Alert is based on: Greenhall G, and others. Organ Transplants From Deceased Donors With Primary Brain Tumors and Risk of Cancer Transmission. JAMA Surgery 2023; 158: 504 – 513.
Information on taking part in NIHR research involving transplants.
Information and support for people waiting on an organ transplant from the Transplant Patient Trust.
A similar study about the risk of cancer transmission from donors who died of brain cancer: Watson CJE, and others. How safe is it to transplant organs from deceased donors with primary intracranial malignancy? An analysis of UK Registry data. American Journal of Transplantation 2010; 10: 1437 – 1444.
Funding: This study was supported by the NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation.
Conflicts of Interest: One author is Medical Director of Organ and Tissue Donation and Transplantation for NHS Blood and Transplant. Two others have received fees and funding from pharmaceutical companies unrelated to this study. Details are provided in the original paper.
Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
