
Transmission of cancer by a single multiorgan donor to 4 transplant recipients - bdz
https://onlinelibrary.wiley.com/doi/pdf/10.1111/ajt.14766
======
mhalle
The opposite problem is a compelling one as well. My transplant surgeon says
that "Snow White isn't going to be your organ donor", meaning that patients
must understand that every organ will have flaws and exposure to disease,
exposure to imperfect lifestyles, etc.

None are perfect. But transplant recipients don't need a perfect organ. They
just need one that will get them through their natural life. A "good enough"
one.

This mindset is important for the moment when an organ becomes available. Many
patients on the wait list for organs actually turn down donor offers because
of some imperfection the doctor told them about. In fact, some people turn
down an organ just because another patient previously turned it down - even
though the reason might have nothing to do with the viability of the organ
itself. The consequences of such a decision can be fatal.

Instead, my surgeon pioneered the idea of transplanting Hepatitis C infected
livers into patients who needed transplant because of HepC-driven liver
failure. His idea was that young people recently infected with HepC who die
tragically are often in otherwise excellent health (HepC is a slowly
progressing disease) and make good donors.

His work allowed him to clear out the backlog of patients awaiting liver
transplant at his center, with success rates as good as any other hospital.
And today, it's possible to kill HepC with anti-viral agents post-transplant.

(Minor edit for clarity.)

~~~
walshemj
Interesting - actually saying yes to a transplant is a big step many people
cant say yes the first time I could not for example.

I did pass on one kidney where the donor might have been hiv+ - the surgeons
second line was don't worry they have really good drugs for HIV now. I still
had ok kidney function so thought it was best to let some one else in worse
health have the kidney.

~~~
jjaredsimpson
I couldn't imagine accepting that. What about having sex? And the cost of
drugs? That seems like a ridiculous options. Especially with the "might have"

~~~
walshemj
Depends how ill you are - I was still managing without dialysis at that point.

------
pkaye
I'm on a kidney transplant list myself. I'm already aware there is a higher
risk of cancer than the average population. But one had to live with the cards
dealt in life so I have to accept that risk.

I'm also hoping for the success of the UCSF artificial kidney. They are in
early stage testing in humans.
[https://pharm.ucsf.edu/kidney](https://pharm.ucsf.edu/kidney) I think if you
read up on it, there is a lot of opportunities for budding young bioengineers
and material scientists to help improve on this technology. They build a
precision pore size filter and coat it with human cells.

~~~
Waterluvian
Reminds me of chemotherapy and countless other medical procedures. We do the
best with what we've got. It's not like we're going to collectively say, "not
going to do anything until we've come up with the _perfect_ solution to this
ailment." To an extent, I try to keep this in mind when arguing with the
engineering devil on my shoulder that constantly shouts, "no, you have to do
it _right!_ "

I imagine your prognosis without a transplanted kidney is markedly worse.

~~~
pkaye
I met up with a transplant patient at a seminar for candidates. Her kidneys
were going bad 20 years ago but it was manageable. She ended up getting
leukemia 10 years ago and went through the chemo. Then 5 years ago she got
diabetes around the time she had to start dialysis. Then 2 years ago when she
was about to get a transplant, they found out she had some heart issues due to
the chemo treatment and needed some surgery. She finally got the kidney
transplant beating all odds and now looks in great shape looking 10 years
younger. I was greatly inspired by her journey.

Its possible to live reasonably long with dialysis if you don't have other
health issues but yeah a kidney transplant is a lot better.

~~~
Ntrails
HaemoDialysis is miserable. You feel shit ~5 days out of 7, it's exhausting
and depressing and it never gets better. Transplant is infinitely preferable
if it's an option.

CAPD is arguably less miserable as a dialysis option but the day to day
lifestyle is not exactly ideal

~~~
walshemj
I have done both and did not get those side effects I only did HD for a few
months and did CAPD for a year. PD is better if you can do it at home I manged
to commute to London on PD.

Note HD is where they filter the blood directly, CAPD /PD is where you pump a
saline solution inside you.

------
byteCoder
As a melanoma survivor, I'm no longer eligible to be an organ donor. In fact,
I could even donate blood until the American Red Cross changed their
guidelines for eligibility in 2017:

Benign cancer or tumor: Acceptable to donate

Basal cell carcinoma: Deferred for four weeks after date of surgical removal

Squamous cell carcinoma (skin, cervix, or oral cavity): Deferred for four
weeks after date of surgical removal

Malignant cancer (e.g., breast, prostate, or colon cancer and melanoma):
Deferred for one year after treatment is completed

Leukemia, Hodgkin’s and non-Hodgkin’s lymphoma, and myeloma: Ineligible to
donate permanently

Kaposi’s sarcoma: Ineligible to donate permanently

~~~
tamcap
Also, for blood at least: 5 years (cumulative) in Europe: Ineligible to donate
permanently

Which drives me nuts...

~~~
jimmy1
Don't donate to the Red Cross anyways. I was a long time donor and I recently
told them off when I actually took the time to read the packets and
disclosures and it turns out they ship your blood off to universities for
testing and research -- with or without your consent, which I object to on
principle alone, but also there is now a moral unknown for me if my blood is
going towards research I morally object to. Again, maybe not most people's
here problem with it, but on principle I do not like not being in control of
what is done with own blood (I want it to go help people, not be test
subjects), and probably most people here can at least agree with that.

Also, they sell your blood to hospitals at a hefty markup. Donate directly to
the hospitals -- most if you walk in and say you are there to donate blood
will happily accept you. Second best is probably a community blood center.

~~~
sigi45
Is this different than in Europe? We do have lots of high profile University
Hospitals. Hospitals around / with university for our highest education and
research.

Why would you not to donate blood to them?

~~~
ekianjo
> Why would you not to donate blood to them?

Because you may want your blood to be used for saving people, not to conduct
random experiments.

~~~
rleigh
Even if it's surplus to requirements? It has a shelf life, demand is variable,
and it's a better fate than simply throwing it away.

I'm a regular donor in the UK, and it also happens to our donations. It can be
used as is, separated into different blood products (plasma, platelets etc.),
or used for research purposes. It's not realistic to expect it only to be used
for transfusions; there's a lot of uses for it in addition, and I can't see
why you would want to control that.

The immunology research group I used to work in routinely received blood
deliveries from the NHS blood service. It was used for HIV research if I
recall correctly, and was done in partnership with the NHS.

------
anonymfus
A mirror of the article's PDF:
[https://docdro.id/2T39U2W](https://docdro.id/2T39U2W)

------
caymanjim
I had lymphoma, which is categorized as a blood cancer. As a result, I'm not
allowed to donate blood (ever again) or organs. The thing is, I'm almost
certain that this isn't recorded anywhere. Not that I want it being recorded
(on principle for privacy rights; I don't actually care), but I'm pretty sure
I could donate both blood and (I hope never to be in this situation) organs,
and no one would be any the wiser.

------
andy_ppp
It probably doesn’t help that the same drugs that stop you rejecting organs
hammer your immune system and weaken it’s surveillance for foreign entities.

------
_rpd
Donated her kidneys, lungs, liver and heart. All four recipients developed a
similar breast cancer.

~~~
anonymfus
Heart recipient died from sepsis before developing cancer. There were two
kidney recipients, right kidney recipient remains alive because of
nephrectomy.

------
maxander
If that wasn’t surprising enough for you- there’s a cancer line that has been
propagated between dogs for _centuries_ :
[https://en.m.wikipedia.org/wiki/Canine_transmissible_venerea...](https://en.m.wikipedia.org/wiki/Canine_transmissible_venereal_tumor)

------
killjoywashere
Now, imagine a blood donor with occult disease... To my knowledge a case of
carcinoma (epithelial cell origin) transmitted via blood donation has not been
recorded yet, however, hematologic maligancies are theoretically very
possible.

------
hooloovoo_zoo
It's interesting to me that the survivor required chemotherapy in addition to
removing the immune system suppressants. Perhaps the immune system evading
strategies of tumors can be exploited in future transplant operations?

~~~
killjoywashere
> the survivor required chemotherapy in addition to removing the immune system
> suppressants

Ah ... probably they took a "belt and suspenders" approach.

------
mataug
I'm not too surprised by the fact that cancer is transmittable via organ
donation.

I'm just surprised that the donor wasn't screened for probability of cancer
using a DNA test. Or is that not possible ?

~~~
btilly
That is not possible.

What presumably happened is that there was an undetected early cancer. That
left circulating tumor cells throughout a body otherwise filled with healthy
tissues. Unless you find those specific cells, there will be no sign of a
problem. (At least not until they find a home and start a new cancer.)

See
[https://en.wikipedia.org/wiki/Circulating_tumor_cell](https://en.wikipedia.org/wiki/Circulating_tumor_cell)
for more.

~~~
matthewrudy
I'm surprised about this.

I get that there can be circulating cells, but the probability of them
successfully metastasising in the early stages is very low.

Normally it's only later stage cancers that end up spreading.

I guess it's down to the immunosuppression making metastasis more viable.

~~~
throwaway234287
I'm not an expert, but my understanding is that the probability or rate (or
expected time) of metastasizing varies a lot depending on the type of the
tumor. (I looked into this a bit when I was diagnosed; it was more or less
likely to metastasize within a somewhat short time, depending on the exact
type of the tumor.)

I'm sure the immunosuppressants needed after a transplant would increase the
risk in any case.

------
frenchman_in_ny
Cancer is a risk of long-term use of immunosuppressants in transplant
populations as well[0].

[0]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2865745/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2865745/)

------
DoreenMichele
I just wish outcomes like this were stronger motivation for the world to work
harder on other solutions. But it never seems to go that direction. Instead,
it spurs discussion of finding ways to improve transplants.

~~~
mhalle
That's because transplants save thousands of lives every year, rapidly turning
some of the sickest people this side of death into healthy, productive,
_living_ individuals.

As a liver transplant survivor, it's hard to describe how dramatic a cure
transplant represents.

Of course, there is a great price: my life in exchange for the donor's. And so
many people are listed for transplant who never receive an organ.

Those facts and the threat of disease, among many others, drive the research
into alternatives (xenotransplantation, synthesized organs, etc). But
transplant is currently the only hope for the desperately hopeless facing
organ failure.

~~~
DoreenMichele
None of that is actually a rebuttal.

~~~
dylan604
What kind of rebuttal are you looking for? Transplant surgery saves lives now.
Any new method is an unknown time away. Is the world supposed to stop saving
lives with the known working method with all of its pros and cons in order to
spend that money developing something that may or may not ever happen? From
where I see it, trying to improve upon an existing method so the success
rate/viability after the procedure increases is not a wasted effort. It's kind
of like refactoring code that already works. You plow through it to get to
work originally, then you go back and keep tweaking it until it no longer
crashes or has bugs and works as efficiently as possible.

~~~
DoreenMichele
I'm not looking for a rebuttal at all. I don't see why the sentiment needs to
be decried, shot down and downvoted.

Why is it such a crime to wish for more research into other approaches? That
sentiment in no way suggests any of the ugly things you are taking it to mean.

~~~
dekhn
It's not a crime to wish for more research, but the total amount of research
dollars is currently fixed (you can't just ask for more and get it, you ask
for more and somebody else doesn't get it), and the methods that already work
today, already work without additional research investment.

~~~
DoreenMichele
My comments on a public forum have exactly zero impact on how research dollars
get spent. The limited nature of research funds is absolutely not reasonable
justification for downvoting my initial comment and for multiple people
feeling compelled to shoot me down for daring to voice it.

------
gammateam
wouldn't this help narrow down the series of events and influences to cause
these cellular errors?

------
delbel
probably a parasite

