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treated with radiotherapy, chemotherapy, ventriculoperitoneal or ventricyloatrial shunts, or extensive craniotomies, as they may open pathways for malignant spread.1,2

A much more difficult decision arises when a donor has a history of cancer treatment in the remote past. Most surgeons would accept a five year disease-free interval as evidence of "cure". However, it is well recognized that late metastases may occur from carcinomas of the breast, or colon, or from malignant melanomas. On rare occasions these may be present as micrometastases at the time of organ retrieval and a diseased organ could be transplanted. The transplant surgeon has to evaluate each donor on an individual basis, and weigh the small risk of transplanting cancer with organs from such a donor, against the chance of discarding potentially usable organs, at a time when there is a profound shortage of cadaver organs.

During organ retrieval surgeons should carefully examine all accessible intrathoracic and intra-abdominal organs for evidence of cancer.1,2 This has occasionally yielded positive findings, particularly with primary renal carcinomas, so that a particular donor or organ was not used.

Theoretically every cadaver donor should have, an autopsy examination performed as expeditiously as possible and before any organs are transplanted. In actual practice permission for autopsy examination is seldom given, and if an autopsy is performed this is usually done after organs have been transplanted. Furthermore, the pathologists' need to fix the brain in preservative for a week or more often delays the results of an autopsy for several weeks. To complicate matters further, even when an autopsy is performed at the donor hospital, the results may not be made available to the various recipient teams. Therefore, an added onus falls on the procurement team to check with the donor hospital regarding any untoward autopsy findings.1,2

The danger of inadvertently transmitting malignancies from donors to recipients must be viewed perspective. Most reported cases occurred in the pioneering era of transplantation, when the risks not appreciated. Over 400,000 solid organ transplants have been performed, but only a handful of transmitted tumors have occurred. Nowadays, with careful selection of donors, inadvertent transplantation of cancer should be a rare event.1,2

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