It's a devastating case that serves as the medical warning we didn't even know we needed. An organ donor didn't just pass on her kidneys, lungs, liver, and heart to five desperate recipients – she also unknowingly bequeathed her undetected, malignant cancer at the same time.
In doing so, this insidious transmission – which scientists only discovered months later – ended up killing three of the patients, researchers report in what they describe as an unprecedented, "extraordinary case".
While patients who are known to have malignant tumours are often unable to donate organs, in this case the 53-year-old donor had no such known condition, and ended up posthumously giving her left kidney, right kidney, lungs, liver, and heart to five separate recipients.
Sadly, of these five people, three ultimately died from donor-derived breast cancer that was never discovered in the lead-up to the donations, a team led by nephrologist Frederike J. Bemelman from the Academic Medical Centre, Amsterdam reports in a recent case note.
"Many reports have shown that cancer transmission can occur in solid organ transplantation," the authors write.
"However, this is the first report describing breast cancer transmission after a multi-organ procedure from one donor to four recipients."
In the case, the 53-year-old donor died from a stroke in 2007. Prior to her death, her donor report – entailing a complete physical examination, including X-rays, ultrasound, and other laboratory tests – indicated nothing to suggest she might have malignant tumours.
In light of that, the organ donations took place after she died, with the recipient who received her heart dying of sepsis (unrelated to the cancer) five months after the transplantation.
Several months after that, the patients whose bodies had accepted their new organs began developing problems of their own.
Sixteen months after the transplant, in August 2008, the double-lung recipient, a 42-year-old female at the time of the transplant, began to experience transplant dysfunction, and hospital tests revealed she had tumours in her epithelial tissue, which later spread elsewhere in her body.
She passed away in 2009, with tests indicating breast cancer cells that were derived from the donor.
Upon her death, physicians consulted the recipient who received the left kidney, who was 62 years old when she received the organ. Initial tests did not indicate she had cancer, and it was not considered possible to remove the organ.
Unfortunately, she fell ill five years later, with tests revealing cancer transmitted from the donor spreading through her kidney, liver, bone, and elsewhere. Two months later – six years after her successful transplant – she passed away.
The liver recipient – a 59-year-old female – experienced a similar saga, with a tumour derived from the donor detected four years after the transplant. She managed the disease for three years, but died seven years after the donation.
Of the four organ recipients, one did live after contracting cancer from the donor. The 32-year-old male, who received the right-kidney, also showed evidence of carcinoma in 2011, so underwent a kidney removal (nephrectomy), and was successfully treated with cancer-suppression drugs.
"In August 2012, complete remission was noted," the authors write.
"At the last follow-up in April 2017, the patient was still free of tumours and wished to undergo a second transplant."
It's not known how the cancer was able to be transmitted in each of the four patients, but the researchers hypothesise that immunosuppressant drugs – designed to help their bodies accept the new organs – might have helped the undetected tumours spread.
While the risk of tumour transmission is usually very low due to rigorous screening – between 0.01 and 0.05 percent for each solid organ transplant, the authors note – the team says even more detailed donor assessments could help prevent tragic cases like this.
On the upside, the successful organ removal and treatment of the right-kidney recipient augurs well for any future repeats of this exceptional kind.
"This extraordinary case points out the often fatal consequences of donor-derived breast cancer," the team writes, "and suggests that removal of the donor organ and restoration of immunity can induce complete remission."
The findings are reported in the American Journal of Transplantation.