Whole Body CT Imaging in Deceased Donor Screening for Malignancies

Abstract

Background. In most western countries, the median donor age is increasing. The incidence of malignancies in older populations is increasing as well. To prevent donor-derived malignancies we evaluated radiologic donor screening in a retrospective donor cohort. Methods. This study analyzes the efficacy of a preoperative computed tomography (CT) scan on detecting malignancies. All deceased organ donors in the Netherlands between January 2013 and December 2017 were included. Donor reports were analyzed to identify malignancies detected before or during organ procurement. Findings between donor screening with or without CT-scan were compared. Results. Chest or abdominal CT-scans were performed in 17% and 18% of the 1644 reported donors respectively. Screening by chest CT-scan versus radiograph resulted in 1.5% and 0.0% detected thoracic malignancies respectively. During procurement no thoracic malignancies were found in patients screened by chest CT compared with 0.2% malignancies in the radiograph group. Screening by abdominal CT-scan resulted in 0.0% malignancies, compared with 0.2% in the abdominal ultrasound group. During procurement 1.0% and 1.3% malignancies were found in the abdominal CT-scan and ultrasound groups, respectively. Conclusions. Screening by CT-scan decreased the perioperative detection of tumors by 30%. A preoperative CT-scan may be helpful by providing additional information on (aberrant) anatomy to the procuring or transplanting surgeon. In conclusion, donor screening by CT-scan could decrease the risk of donor-derived malignancies and prevents unnecessary procurements per year in the Netherlands.

Reply to: Balancing Cost and Efficiency in Screening Potential Organ Donors With Whole Body CT

“…We appreciate the comments of Lormans et al regarding our recently published article “Whole Body CT Imaging in Deceased Donor Screening for Malignancies” on the screening of organ donors and thank them for the opportunity to respond and clarify a few points. 1 , 2 …”

“…Based on Tables 4 and 5 of our recently published article, Lormans et al suggested that in our series, only 3 unnecessary procurements were prevented in contrast to the 7 preventable procurements mentioned in the last paragraph of the discussion. 1 , 2 We would like to clarify that the number of approximately 7 procurements in 5 years of the previously mentioned article is based on a 0.44% absolute risk reduction of malignancies found during procurement (Table 3). 2 In fact, in the chest radiograph, group 2 malignancies and, in the abdominal ultrasound group, 15 malignancies were missed (1 lesion turned out to be benign), whereas none in the thoracic computed tomography (CT) group and only 3 in the abdominal CT group were missed (Table 5).…”

“…1 , 2 We would like to clarify that the number of approximately 7 procurements in 5 years of the previously mentioned article is based on a 0.44% absolute risk reduction of malignancies found during procurement (Table 3). 2 In fact, in the chest radiograph, group 2 malignancies and, in the abdominal ultrasound group, 15 malignancies were missed (1 lesion turned out to be benign), whereas none in the thoracic computed tomography (CT) group and only 3 in the abdominal CT group were missed (Table 5). If all reported donors would have been screened by CT scan, approximately 7 (0.44%*1644) a procurements could have been prevented.…”

“…If all reported donors would have been screened by CT scan, approximately 7 (0.44%*1644) a procurements could have been prevented. 2 …”

Balancing Cost and Efficiency in Screening Potential Organ Donors With Whole Body CT

“…The authors reported that whole body CT in deceased donors decreased periprocurement detection of malignancies by 30% (from 0.2% and 1.3% to 0% and 1% for thoracic and abdominal CT, respectively). 1 Although whole body CT seems justifiable to screen donors, these findings raise questions whether CT as a screening method could not be used more cost-efficiently. We calculated that whole body CT comes with an extra cost of 337,028€/5y or 67,405€/y.…”