Perceived Versus Verified Cancer History and Missed Opportunities for Donation in an Australian Cohort of Potential Deceased Solid Organ Donors

Hedley, James; Kelly, Patrick J.; Waller, Karen; Thomson, Imogen K.; Mata, Nicole De La; Rosales, Brenda; Wyburn, Kate; Webster, Angela C

doi:10.1097/txd.0000000000001252

Cited by 6 publications

(26 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Among 172 potential donors declined due to cancer, 13 with decision support one additional donor with low-risk PBM (2%) would have been accepted, increasing overall donation 0.3%. With real-time data-linkage, 2 additional donors would have been accepted: one low-risk (2%) and one not contraindicated (0.1%).…”

Section: Resultsmentioning

confidence: 99%

“…A major strength of our study is our use of data for all potential donors from NSW, 13 which has a centralized donation service. This allowed us to capture missed opportunities for donation from donors with PBM that may not have been reported in other jurisdictions.…”

Section: Discussionmentioning

confidence: 99%

“…We considered 3 interventions that have previously been proposed to increase utilization of organs from deceased donors with cancer 13 and compared them with current practice (ie, individual clinicians deciding which potential donors with PBM to accept or decline). Comparators were (1) decision support for clinicians in accurately estimating absolute donor risk for cancer transmission; (2) improved clinical information with greater accuracy through real-time data-linkage to hospital records and cancer registries to improve classification of potential donor cancer type and hence transmission risk; and (3) increased risk tolerance to allow use of donors with intermediate-risk PBM (estimated transmission risk 6.4%).…”

Section: Methodsmentioning

confidence: 99%

“…Comparators were (1) decision support for clinicians in accurately estimating absolute donor risk for cancer transmission; (2) improved clinical information with greater accuracy through real-time data-linkage to hospital records and cancer registries to improve classification of potential donor cancer type and hence transmission risk; and (3) increased risk tolerance to allow use of donors with intermediate-risk PBM (estimated transmission risk 6.4%). 13 , 14 More detail about these comparators is provided in Appendix 2, SDC , http://links.lww.com/TXD/A523 .…”

Section: Methodsmentioning

confidence: 99%

“…A recent study demonstrated that only 74% of perceived brain cancers among potential donors could be verified as malignant in linked medical records. 13 Furthermore, estimates of PBM transmission risk in clinical practice guidelines 14 are highly variable and based on studies with no observed transmissions. 11 , 12 These guidelines are similar to those used in the United States, 15 the United Kingdom, 16 and EU 17 and recommend accepting donors with a low risk of transmission (<2%) and permitting donors with an intermediate risk of transmission (6.4%) on a case-by-case basis.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Cost-effectiveness of Interventions to Increase Utilization of Kidneys From Deceased Donors With Primary Brain Malignancy in an Australian Setting

Hedley

Kelly

Wyld

et al. 2023

Transplantation Direct

Self Cite

View full text Add to dashboard Cite

Background. Kidneys from potential deceased donors with brain cancer are often foregone due to concerns of cancer transmission risk to recipients. There may be uncertainty around donors’ medical history and their absolute transmission risk or risk-averse decision-making among clinicians. However, brain cancer transmissions are rare, and prolonging waiting time for recipients is harmful. Methods. We assessed the cost-effectiveness of increasing utilization of potential deceased donors with brain cancer using a Markov model simulation of 1500 patients waitlisted for a kidney transplant, based on linked transplant registry data and with a payer perspective (Australian government). We estimated costs and quality-adjusted life-years (QALYs) for three interventions: decision support for clinicians in assessing donor risk, improved cancer classification accuracy with real-time data-linkage to hospital records and cancer registries, and increased risk tolerance to allow intermediate-risk donors (up to 6.4% potential transmission risk). Results. Compared with current practice, decision support provided 0.3% more donors with an average transmission risk of 2%. Real-time data-linkage provided 0.6% more donors (1.1% average transmission risk) and increasing risk tolerance (accepting intermediate-risk 6.4%) provided 2.1% more donors (4.9% average transmission risk). Interventions were dominant (improved QALYs and saved costs) in 78%, 80%, and 87% of simulations, respectively. The largest benefit was from increasing risk tolerance (mean +18.6 QALYs and AU$2.2 million [US$1.6 million] cost-savings). Conclusions. Despite the additional risk of cancer transmission, accepting intermediate-risk donors with brain cancer is likely to increase the number of donor kidneys available for transplant, improve patient outcomes, and reduce overall healthcare expenditure.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Cost-effectiveness of Interventions to Increase Utilization of Kidneys From Deceased Donors With Primary Brain Malignancy in an Australian Setting

Hedley

Kelly

Wyld

et al. 2023

Transplantation Direct

Self Cite

View full text Add to dashboard Cite

show abstract

Donor Cancer Transmission: Focusing on the Evidence

Nalesnik

2022

Transplantation

View full text Add to dashboard Cite

Transmission and Non-transmission of Melanoma From Deceased Solid Organ Donors to Transplant Recipients: Risks and Missed Opportunities

Rosales,

Hedley,

De La Mata

et al. 2024

Transplantation

Self Cite

View full text Add to dashboard Cite

Background. Biovigilance concerns are in tension with the need to increase organ donation. Cancer transmission risk from donor to recipient may be overestimated, as non-transmission events are rarely reported. We sought to estimate melanoma transmission risk in deceased organ donation and identify missed opportunities for donation in an Australian cohort with high melanoma prevalence. Methods. We used a population-based approach and linked deceased organ donors, transplant recipients, and potential donors forgone, 2010–2018, with the Central Cancer Registry (CCR), 1976–2018. We identified melanomas using ICD-O-3 classification, assessed the probability of transmission, and compared suspected melanoma history in potential donors forgone with melanoma notifications in the CCR. Results. There were 9 of 993 donors with melanoma in CCR; 4 in situ low-risk and 5 invasive high-to-unacceptable risk. Four were unrecognized before donation. Of 16 transplant recipients at risk, we found 0 of 14 transmission events (2 recipients had insufficient follow-up). Of 35 of 3588 potential donors forgone for melanoma risk alone, 17 were otherwise suitable for donation; 6 of 35 had no melanoma in CCR, 2 of 35 had in situ melanomas and 9 of 35 had thin invasive melanomas (localized, ≤0.8 mm thickness). Conclusions. Our findings contribute to current evidence that suggests donors with melanomas of low metastatic potential may provide an opportunity to safely increase organ donation and so access to transplantation.

show abstract

Perceived Versus Verified Cancer History and Missed Opportunities for Donation in an Australian Cohort of Potential Deceased Solid Organ Donors

Abstract: Supplemental Digital Content is available in the text.

Cited by 6 publications

References 13 publications

Cost-effectiveness of Interventions to Increase Utilization of Kidneys From Deceased Donors With Primary Brain Malignancy in an Australian Setting

Cost-effectiveness of Interventions to Increase Utilization of Kidneys From Deceased Donors With Primary Brain Malignancy in an Australian Setting

Donor Cancer Transmission: Focusing on the Evidence

Transmission and Non-transmission of Melanoma From Deceased Solid Organ Donors to Transplant Recipients: Risks and Missed Opportunities

Contact Info

Product

Resources

About