Organ donation after PCa

I've been thinking about the topic of post-PCa organ donation. For example, can a person who had PCa (fully cured with many years of zero PSA after surgery/brachy/etc) donate organs? Is there a difference between living donation (bone marrow or a kidney) and organ donation after death?

Google helped me find this HW thread. It seems that as long as the donor doesn't have "active" cancer, that organ donation is acceptable.

But then I started to think further...
Many on HW say that most men have a strong chance of active PCa during their lifetime. (An often quoted rule-of-thumb is that a 60yo man has a 60% chance, 70yo man has a 70% chance, etc.) If so, then it would seem to me that in all cases where a man dies and his organs are being harvested for donation, the prostate would need to be removed and examined by a pathologist for presence of "active" PCa before his other organs (liver, heart, corneas, etc) could be transplanted into living recipients. I doubt that this is actually done in practice. Therefore, I question why a living person with "active" PCa could not donate a kidney, but a dead man who is likely to have "active" PCa would be able to donate.

Thoughts?

Gedman

I think I can help clarify in the context of some numbers you used in your posting… It is correct that about 60% of 60 year olds were found to have diagnosable prostate cancer when autopsies were performed on men who died accidently, and 70% 0f 70 year olds, etc.  Most didn't know they had it; the precentage diagnosed at those ages is much lower and the percentage who are ever bothered by PC is even much lower. These statistics are often quoted to emphasize proof of how extraordinarily high the number of indolent prostate cases there are in comparisonn to the small (in comparison) number of high-grade PC cases.  For the low-grade cases, it is merely that some of those men have run across the set of circumstances in their lives which led to a biopsy, followed by the high likelihood of having PC found/diagnosed (obviously because of the high likelihood of it’s presence). This autopsy statistic is the foundation of why we tell men diagnosed with low-risk cancer—and especially those who have not yet had their 2 nd confirmatory re-biopsy within about a year— not to rush into treatment.   Immediate aggressive treatment is not needed, and not recommended by the prostate cancer medical experts in such cases.  The confirmatory biopsy successfully weeds out a percentage of cases who move on to successful treatment, while providing confidence to those who continue onto a Active Surveillance protocol.   So, as it may relate to organ donation, we know that prostate cancer is not a one-way street. Small tumors may appear, grow a bit, and then go away.   Some pathologists and urologists don’t even think that we should even be calling the lowest grade of PC by the term “cancer;” rather, something like “weird cells” or some similar less “scary” term, and that the phrase “cancer” should be reserved for tumors that can kill people.   We all harbor abnormalities in our bodies, and our tests are increasingly able to find them.   Important perspectives to keep in mind in all things PC-related…       Post Edited (Casey59) : 11/10/2013 3:00:54 PM (GMT-7)

I was told by my uro and my GP that if you are under treatment or active observation, in my state, you cannot donate organs. Seems that you have to have no evidence of cancer detected in the last 5 years. It came up when someone I know needed bone marrow. I filled out the form, but was told by the nurse checking specs that I could leave without getting typed, as I would never be able to donate organs, or even blood for that matter. So I asked around, and at least in my case, I'll head off to the graveyard intact (0k, minus a prostate and my tonsils).

142 said...
I was told by my uro and my GP that if you are under treatment or active observation, in my state, you cannot donate organs. Seems that you have to have no evidence of cancer detected in the last 5 years.

This makes sense because it is the same as the guidelines for blood donation -- no evidence of cancer in the last 5 years. But now this has me wondering - I have an organ donor symbol on my driver license and a signed and witnessed card behind my license in my wallet authorizing organ donation. I'm now wondering if I should get a new license without the organ donor graphic in the corner.

Gedman, I would then ask what is required to define "full remission".

In looking at all this again, I discovered yet another block.

The agencies I would work with disqualify anyone who lived in certain countries for a cumulative total of more than 5 years between 1980-1996 (potential mad cow exposure, I suspect). I did, so yet another reason to go to my rest intact.

Interesting. The last time I was part of a corporate blood drive, I was not eligible because of active cancer within the previous 5 years. But after reading Gedman's post above, I just checked the Red Cross site and found this:

"Cancer
Eligibility depends on the type of cancer and treatment history. If you had leukemia or lymphoma, including Hodgkin’s Disease and other cancers of the blood, you are not eligible to donate. Other types of cancer are acceptable if the cancer has been treated successfully and it has been more than 12 months since treatment was completed and there has been no cancer recurrence in this time. Lower risk in-situ cancers including squamous or basal cell cancers of the skin that have been completely removed do not require a 12 month waiting period.

Precancerous conditions of the uterine cervix do not disqualify you from donation if the abnormality has been treated successfully. You should discuss your particular situation with the health historian at the time of donation."

So I guess I won't worry about the "organ donor" notation on my license. And I may now be eligible to donate blood again. I'm now 3 years since salvage radiation. Though despite my current PSA, I'm not convinced I'm cancer-free. Maybe I'll feel more confident after a couple of more zeros.

"Worried"
A good suggestion. I have a friend who's wife was an anatomy professor. She donated her body. Something to think about, given that up to now, my plan has been to go up in smoke.

I would expect that the autopsy would reveal PCa, and that if found, the donations would have to be called back.

I just found this article. Haven't read the whole thing yet, but it might shed some light on this topic.

Organ transplantation from deceased donors with cancer: is it safe?

The article Abstrat said...
Abstract: The availability of donor organs continues to be insufficient to meet the needs of patients actively waiting for transplant. Consequently, there is continuing pressure to increase the donor organ pool while simultaneously assuring safety for the recipient population. The complication of donor malignancy transmission has been documented almost from the beginning of transplantation, and continues to be a concern today. The anecdotal nature of case reports and compiled series ensures that clinical decisions related to organ use from donors with malignancy will of necessity continue to be made on the basis of low-level evidence. Despite this limitation, the literature indicates that not all donor neoplasms have the same risk for transmission to the recipient, and it is necessary to consider the specific malignancy affecting the donor, as well as the condition of the recipient, before a decision is made to transplant or discard a given organ.
Published cases suggest that certain forms of neoplasia, such as melanoma, choriocarcinoma,
sarcoma, small cell carcinoma, or metastatic carcinomas serve as strong contraindications to
organ donation. In contrast, considerable experience exists to suggest that certain tumors of the
central nervous system, small subclinical prostate carcinomas, or small renal cell carcinomas
resected prior to transplant, among other tumors, should not in themselves disqualify an individual from donating organs in the appropriate circumstance. This review presents the case for considering organ transplantation in the setting of certain donor malignancies and discusses factors to be weighed in such decisions. Additionally, donors with a history of cancer are considered, and features that may aid in reaching a conclusion for or against transplantation of organs from these patients are presented.

Special section on PCa said...
Prostate carcinoma The American Cancer Society estimates 217,730 new
cases of prostate cancer in the US in 2010.16 Worldwide, the GLOBOCAN2008 Project of the International Agency for Research on Cancer estimated 899,000 new cases of prostate cancer in 2008, with the highest incidence (104.2 per 100,000) in the Australia/New Zealand region.47

Risk of tumor development is age-dependent, with the American Cancer Society estimating a 2%, 6%, and 8% risk of cancer in white males, and a 4%, 10%, and 11% risk in black males, in the 50–59, 60–69 and 70–79 year ranges, respectively. These figures are of concern, given the increasing use of elderly donors. In an evaluation of prostate glands from 340 organ donors, Yin et al20 found adenocarcinoma in a total of 41 (12%) donors, with 23.4% in the 50–59, 34.7% in the 60–69, and 45.5% frequency in the 70–81 year ranges.

Despite these figures, donor-associated prostate adenocarcinomas have only rarely been reported, with the original report by Loh et al frequently cited in the literature. The donor in that case had carcinoma extending into the seminal vesicles with metastases to the pelvic lymph nodes and adrenal glands (Stage IV), discovered after heart transplant had begun.

Kauffman et al 48 reported three organs transplanted from donor(s) with prostate carcinoma, with no evidence of transmission, based on the OPTN/UNOS database. A more recent report from the UNOS DTAC covering the years 2005–2009 showed five donors with prostate carcinoma, with no reports of confirmed malignancy transmission. 49 50 Pretagostini et al, reporting for the Italian Centro Na zionale Trapianti, found carcinoma of the prostate to be the commonest donor malignancy in their series, and reported no tumor transmission in organs recovered from three donors with in situ to intermediate degree tumors. They considered high degree prostate carcinoma a contraindication to transplant, but did not provide definitions of these terms.

In light of the near absence of case reports of donor associated prostate carcinomas despite increased use of elderly donors, it seems likely that small incidental prostate carcinomas restricted to the gland have extremely limited risk for transmission via standard organ transplantation. The same cannot be said for more advanced/metastatic tumors, although it would be presumptuous to be dogmatic with limited evidence. It seems prudent to examine the area at the time of organ removal and consider biopsy only of suspicious masses involving the prostatic region or beyond. However, at present, there is no compelling evidence to recommend routine biopsy of the prostate at the time of organ donation (ie, in the absence of a palpable lesion), especially since frozen section may have decreased sensitivity in detection of malignancy, Gleason score, and presence of extracapsular extension.

The above may explain why it is OK for men with PCa to donate organs after death, despite their PCa. But, it doesn't explain why living guys being treated for PCa couldn't donate a kidney.

-Gedman

Gedman, why have you been thinking about this at 41?

that's fair. just probing to make sure you're not feeling down and depressed because of you're still recent experience with this. 7 months out I still felt very raw about it all.

Five years ago i had robotic prostatectomy and my PSA has remained <.01. A year ago I asked the blood donation center if I could donate blood and they said yes. Today I donated blood again. If donating blood is OK after 4 years of undetectable PSA why shouldn't organ donation be OK?

I've probably wasted altogether too much time looking at this, considering that I am on a list of "can't donate", and have no problems with that.

But I checked the state law online, and looked at the organization site for the legal entity that gathers organs intended to be donated in my area.

- the only way to not have an autopsy is to die as an inpatient in a registered hospital of the illness or affliction for which you were admitted, at least 24 hours after admission, and during which time one single primary physician was in control of your overall care. All other cases require an autopsy be done by the county medical examiner. The medical examiner may forgo the autopsy if he declares the death to be clearly associated to an event for which there is no probable criminal or civil liability. If he does that, and a suit is filed, he is required to exhume the body (if available) and do the autopsy. In all cases the autopsy is without cost to the public (meaning the requesting party, and that's yet another rabbit hole for my tax money).

- the organ donation policy? They say to sign up, and it will be responsibility of the doctors involved to determine the individual cases. They go on to say that potential recipients are so desperate that they will happily deal with post-transplant dire diseases to have even a remote chance of some improvement. They have a very limited list of exclusions, mainly cancers.

I find that approach absurd. Save me from certain death at one hand to pass me to death at the other.