title: Advising potential recipients on the use of organs from donors with primary central nervous system tumors.
abstract: Deciding to use an organ from a donor with a primary central nervous system (CNS) tumor necessitates offsetting the risk of tumor transmission with the chances of survival if the patient waits for another offer of a transplant. Published data vary in the quoted risk of tumor transmission. We used data obtained by reviewing 246 UK recipients of organs taken from donors with CNS tumors and found no evidence of a difference in overall patient mortality for recipients of a kidney, liver, or cardiothoracic organ, compared with recipients of organs from donors without a CNS tumor. Recent publication of the UK experience of transplanting organs from CNS tumor donors found no transmission in 448 recipients of organs from 177 donors with a primary CNS tumor (Watson et al., Am J Transplant 2010; 10: 1437). This 0% transmission rate is associated with an upper 95% confidence interval limit of 1.5%. Using a series of assumptions of risk, we compared the risks of dying as a result of the transmission of a primary brain tumor with the risks of dying if not transplanted. On this basis, the use of kidneys from a donor with a primary CNS tumor provides a further 8 years of life over someone who waited for a donor who did not have a primary CNS tumor, in addition to the life years gained by the transplant itself. The benefits for the recipients of livers and cardiothoracic organs were less, but there was no disadvantage in the impact on life expectancy.
authors.affiliation: Office of the Dean for Education, Barts and the London School of Medicine, Queen Mary, University of London, London, United Kingdom. a.warrens@qmul.ac.uk
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Warrens
authors.forename: Rhiannon
authors.initials: R
authors.lastname: Birch
authors.forename: David
authors.initials: D
authors.lastname: Collett
authors.forename: Maren
authors.initials: M
authors.lastname: Daraktchiev
authors.forename: John H
authors.initials: JH
authors.lastname: Dark
authors.forename: George
authors.initials: G
authors.lastname: Galea
authors.forename: Katie
authors.initials: K
authors.lastname: Gronow
authors.forename: James
authors.initials: J
authors.lastname: Neuberger
authors.forename: David
authors.initials: D
authors.lastname: Hilton
authors.forename: Ian R
authors.initials: IR
authors.lastname: Whittle
authors.forename: Christopher J E
authors.initials: CJ
authors.lastname: Watson
mesh_terms: D016543:Central Nervous System Neoplasms / Q000150:complications*; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008017:Life Expectancy; D016031:Liver Transplantation / Q000401:mortality*; D017063:Outcome Assessment, Health Care; D012307:Risk Factors; D015996:Survival Rate; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014180:Transplantation; D014850:Waiting Lists