A multiorgan donor cancer screening protocol: the Italian Emilia-Romagna region experience.
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.
Fiorentino
Michelangelo
M
Pathology Unit, F. Addarii Institute of Oncology, Viale Ercolani 4/3, 40138 Bologna, Italy.
D'Errico
Antonia
A
Corti
Barbara
B
Casanova
Silvia
S
Ridolfi
Lorenza
L
Venturoli
Nicola
N
Sestigiani
Elena
E
Grigioni
Walter F
WF
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*