Potential organ donors with primary brain tumours: missed opportunities for donation and transplantation identified in Australian cohort study 2010–2015. Issue 11 (21st September 2022)

• Record Type: Journal Article
• Authors: Thomson, Imogen K.; Hedley, James; Rosales, Brenda M.; Wyburn, Kate; O'Leary, Michael J.; Webster, Angela C.
• Is Part Of: ANZ journal of surgery. Volume 92:Issue 11(2022)
• Page Start: 2996
• Page End: 3003
• Publication Date: 2022-09-21
• Subjects: brain neoplasms -- central nervous system neoplasms -- organ donation -- organ transplantation -- transplant recipients; Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.18037
• Languages: English
• ISSNs: 1445-1433

Abstract

Abstract: Background: Potential organ donors with primary brain tumours (PBT) frequently donate, however some may be declined due to uncertainty about tumour classification or transmission risk to transplant recipients. We sought to describe transmission risk and donation outcome of potential donors with PBT, including identifying missed opportunities for transplantation, and any PBT transmission events. Methods: We undertook a population‐based cohort study in NSW of all potential donors 2010–2015. PBT potential donors were characterized according to tumour grade and transmission risk, and whether they donated organs. Data linkage was used to determine agreement of risk assessment of potential donors to that in the Biovigilance Register, and to identify any PBT transmissions. Results: Of 2957 potential donors, 76 (3%) had PBTs. There was agreement of risk assessment in 44 (58%) cases. PBT potential donors had fewer comorbidities (1.6 vs. 2.1, P = 0.006) than non‐PBT potential donors. Forty‐eight (63%) potential donors were declined for non‐PBT reasons, 18 (24%) were declined because of perceived PBT transmission risk and 10 (13%) donated. All PBT donors had WHO‐I or ‐II tumours, and none had a ventriculo‐pertioneal shunt. No transmission events occurred. Conclusion: Donors with WHO‐I/II PBT appear to have minimal risk of tumour transmission in solid organ transplantation; it is reassuring that no PBT transmission occurred. There is evidence of risk aversion to referrals with WHO‐III/IV tumours. There exists opportunity to improve potential donor risk assessment at the time of referral using integrated data sets, and to increase organ donation and transplantation rates through greater utilization of PBT referrals. Abstract : Potential organ donors with primary brain tumours can, in many cases, safely donate organs for solid organ transplantation. There are likely missed opportunities for organ donation among these potential donors. Use of health data sets at the time of evaluation for organ donation can improve medical suitability assessment for transplantation, particularly in cases of potential biovigilance concerns.