title: A multiorgan donor cancer screening protocol: the Italian Emilia-Romagna region experience.
abstract: BACKGROUND
  We describe the Emilia-Romagna screening protocol for all multiorgan donors within this region of Italy and report on the first 2 years of implementation.
  
  
  METHODS
  Setting is a 24-hour multidisciplinary call service covering the 16 intensive care units in Emilia-Romagna (3,969,000 inhabitants) and a centralised pathology center, directed by a transplant coordination center. STUDY POPULATION AND PERIOD: All 271 effective donor candidates presenting in Emilia-Romagna in 2001-2002.
  
  
  METHODS
  Anamnesis, external examination, and thorough laboratory and instrumental screening is followed by sampling of internal effusions and evaluation of all internal organs. All suspect findings are then investigated by extemporary pathologic evaluation. To fit national legal requirements, candidates are classified as standard risk (no transmissible risk); nonstandard risk (low-risk of transmission, eligibility restricted to certified clinical emergencies pending informed consent); and unacceptable risk (unconditional exclusion because of high-risk pathologies).
  
  
  RESULTS
  The protocol was successfully implemented for all 271 candidates. In addition to 14 independent exclusions, clinical suspicion of cancer was raised for 61 donors presenting with 82 lesions or effusions. Along with one case of lymph-node tuberculosis (unacceptable risk), histocytologic screening revealed eight cases of malignancy (5 prostate, 1 papillary-thyroid, 1 follicular-thyroid, and 1 renal cell, all nonstandard risk); the remainder were benign (standard risk). Protocol implementation led to exclusion of 8 (3.0%) candidates (1 nonstandard risk transplantation was performed).
  
  
  CONCLUSIONS
  This stringent protocol-now adopted with some modifications at a national level-provides an initial example of a feasible intervention aimed at maximising donation safety while rationalizing use of marginal donors.
authors.affiliation: Pathology Unit, F. Addarii Institute of Oncology, Viale Ercolani 4/3, 40138 Bologna, Italy.
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Fiorentino
authors.forename: Antonia
authors.initials: A
authors.lastname: D'Errico
authors.forename: Barbara
authors.initials: B
authors.lastname: Corti
authors.forename: Silvia
authors.initials: S
authors.lastname: Casanova
authors.forename: Lorenza
authors.initials: L
authors.lastname: Ridolfi
authors.forename: Nicola
authors.initials: N
authors.lastname: Venturoli
authors.forename: Elena
authors.initials: E
authors.lastname: Sestigiani
authors.forename: Walter F
authors.initials: WF
authors.lastname: Grigioni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D015276:Health Care Rationing; D006801:Humans; D007231:Infant, Newborn; D007362:Intensive Care Units; D007558:Italy; D008297:Male; D009369:Neoplasms / Q000453:epidemiology*; D018579:Patient Selection; D012449:Safety; D014019:Tissue Donors / Q000706:statistics & numerical data*