A multiorgan donor cancer screening protocol: the Italian Emilia-Romagna region experience

Abstract

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.

Predictive value of frozen-section analysis in the histological assessment of steatosis before liver transplantation

“…10 The protocol included an ultrasound liver examination and an evaluation of serum bilirubin and aminotransferases. Wedge and fine-needle liver biopsies were taken from each donor before transplantation at the time of vascular clamping.…”

Donor derived malignancy following transplantation: a review

“…The team should include a pathologist who has an understanding of the cancer and its behavior including the possibility of late metastasis, the transplant team who evaluate the urgency of the situation and the recipient who can make an informed decision. Implementation of a new stringent protocol in Italy (Fiorentino et al 2003) based on a team approach and understanding of the cancer demonstrates how patient safety can be maximized while optimizing the use of marginal donors. In this protocol for cancer-related risks, the donors are stratified into three groups by a pathologist (a) standard risk: absence of any evident risk factor for transmission of cancer, including donors with basal cell skin carcinoma, non-metastatic squamous cell skin carcinoma, in situ carcinoma of the uterine cervix or larynx and papillary non-invasive carcinoma of the urinary bladder.…”

“…However, donors with any grade of tumor with ventriculoperitoneal shunting are not acceptable (Kalble et al 2005). Similar guidelines from Italy consider donors with low-grade tumors (grade 1 and 2) as standard risk, i.e., no evidence of risk factors for tumor transmission, while a select group of high-grade tumors (anaplastic astrocytoma, anaplastic oligodendroglioma, anaplastic oligoastrocytoma, anaplastic ependymoma, choroid plexus carcinoma, and gliomatosis cerebri) are considered as non-standard risk, i.e., donation of life-saving organs is justified by certified clinical urgency, pending informed consent of the recipient (Fiorentino et al 2003). Donors with any other high-grade primary tumors are considered an unacceptable risk.…”

Thyroid nodule and thyroid cancer management pre- and post-cardiac transplantation

“…42 This risk is considered extremely small with respect to waiting-list mortality based on multiple large population studies. 43 A stringent screening protocol for donors in the Italian region of Emilia-Romagna was performed on 271 consecutive candidates. 43 These donors had no clinical evidence of cancer and underwent extensive history, examination, and histopathologic testing.…”

“…43 A stringent screening protocol for donors in the Italian region of Emilia-Romagna was performed on 271 consecutive candidates. 43 These donors had no clinical evidence of cancer and underwent extensive history, examination, and histopathologic testing. Malignancy was confirmed in 8 candidates, with 2 of these having thyroid cancer, 1 each of papillary and follicular.…”