15.08 Risk evaluation of organ donation from donors with primary malignant gliomas

S. Amaefuna1, J. D. Mezrich2, J. S. Kuo1  1University Of Wisconsin,Neurological Surgery,Madison, WI, USA 2University Of Wisconsin,Surgery,Madison, WI, USA

Introduction:  Progress in organ transplantation to treat end-stage organ disease has resulted in organ demand greatly outpacing supply. The escalating organ shortage and rising mortality rates for the estimated 123,000 patients on the U.S. organ wait-list motivated our reevaluation of common practices related to organ donation from individuals with primary central nervous system (CNS) tumors. Malignancy is generally considered a contraindication to organ donation, with rare exceptions including non-metastatic primary brain tumors (PBT). Glioblastoma multiforme (GBM) is a WHO grade IV glioma that accounts for over 45.2% of malignant PBTs in the U.S. Therefore, less than 0.5% of 13,000 U.S. patients dying from malignant gliomas annually serve as organ donors. Although a hallmark feature of GBM is infiltration into surrounding brain, metastatic capacity outside the CNS is poorly documented.

Methods:  Using literature review of all available papers reporting on GBM and extra-neural metastasis, we evaluated and assessed the implications of available data on the rarity of extra-neural metastasis (ENM) of GBM regarding the risk of donor-derived transmission (DDT) of cancer to organ recipients. We evaluated and present recent reports on DDT rates among recipients of cadaveric organs from GBM patients. 

Results: Careful screening of papers for only pathologically confirmed metastatic events were considered high quality, reliable data. Literature review revealed only clinical case reports suggesting a maximum incidence of metastasis that is likely significantly lower than 2%, and highlights that such rare GBM metastatic events preferentially target pulmonary, lymph, hepatic and bone tissues. 

Conclusion: These findings imply that kidneys from donors with GBM may be considered for transplantation, and the morbidity and possible mortality of wait-listed renal allograft recipients may outweigh the apparent small risk of DDT from donors with GBM. Further studies are required to validate this implication before implementing any changes in donor evaluation policy. Furthermore, re-evaluation of policies regarding other lower grade primary brain tumors are being considered for study in order to support the goal of increasing donor organs.