Single Center Series: Donor cancer screening. Verona "Alert" protocol (2017)

Review of cancer screening protocol in a large donor Center (Verona, Italy) with appropriate support by the Pathology Department and availability of histopathological examination when indicated. In a first step all donors were reviewed by clinical charts and all available records / investigations / etc. for evidence of malignancy. Then it was decided whether to proceed to organ procurement and whether to perform addional investigations (of note sometimes biopsy was undertaken to clarify unexplained mass). In a second step at procurement "any" suspicious mass was investigated. Finally it was controlled for a part of the study time (by postmortem examination) how many malignancies were missed. In Brief during step one 41 of 400 donors were excluded for unacceptable risks (10%) whereas 35 malignancies were verified or newly detected during step 2 (9%). finally only in three cases (<1%) was malignancy missed. Based on this latter low rate the recommendation for routine autopsy of every donor was cancelled. Details about the issue of transmission were not well explained. Most frequently prostatic cancer and renal cell cancer were the indication for investigation - 92% of prostate CA and 43% of RCC proceeded to successful transplantation after histopathological examination. In other cases such (breast cancer, larger renal cancers, and one example of each: prostate cancer, thyroid cancer, lymphoma, gastric cancer, colon cancer, lung adenocarcinoma, melanoma, bladder cancer ) the procedure was aborted. One small hepatocellular carcinoma and two small breast carcinomas were first discovered at autopsy. This study stresses an orderly and comprehensive approach to donor transmissible disease evaluation with an emphasis on malignancy and highlights the necessity of histopathologic examination on an immediate basis. They recommend consideration of telepathology in cases in which a supportive Pathology Department is not available. The paper documents the effectiveness of their approach.