A cancer diagnosis does not automatically disqualify an individual from becoming an organ donor after death. The decision to accept a deceased patient’s organs is a complex medical evaluation made on a case-by-case basis. Transplant teams consider numerous factors, but a history of malignancy does not lead to an immediate rejection. The determination hinges on the type of cancer, its current status, and the likelihood of successfully transplanting a functional organ without compromising the recipient’s health.
The Primary Concern: Risk of Cancer Transmission
The primary reason cancer affects donor eligibility is the potential for transmitting malignant cells to the recipient. This risk is magnified by the necessary medical treatment recipients must undergo. Patients receiving a new solid organ, such as a heart, lung, or kidney, must take powerful immunosuppressive medications for the rest of their lives.
These medications are designed to suppress the recipient’s immune system, preventing it from recognizing the new organ as foreign and rejecting it. However, this intentional suppression also severely compromises the body’s natural ability to detect and destroy any cancerous cells that might be introduced through the donor organ. Even microscopic, undetected cancer cells can grow unchecked in this compromised environment, leading to a new, aggressive malignancy in the recipient.
While the actual rate of donor-transmitted cancer is low—estimated to be less than one-tenth of one percent of all deceased donor transplants—the consequences are often severe, including graft loss and death. Strict policies are established by governing bodies to minimize this risk. The transplant surgeon and the medical team must weigh the risk of cancer transmission against the immediate threat of death for the patient waiting for the organ.
Types of Cancer That Prevent Organ Donation
Certain types of cancer represent an absolute contraindication for solid organ donation due to the high risk of dissemination. The most significant concern is any active cancer that has spread throughout the body, known as metastatic disease. When cancer cells have traveled from the primary tumor site, they are likely circulating in the bloodstream and lymph system, contaminating major organs.
Hematologic malignancies, which are cancers of the blood and bone marrow, are typically excluded from donation. This category includes leukemias, lymphomas, and multiple myeloma. Since these cancers originate in the systems that circulate throughout the body, their cells are inherently systemic and pose a high risk of transmission through a solid organ.
Some specific solid tumors, such as aggressive melanoma and choriocarcinoma, are excluded even if they appear localized. These cancers have a known biological tendency to spread early and microscopically. This makes the risk of undetected cancer cells too high for the immunosuppressed recipient.
Navigating Historical Cancer and Localized Tumors
A previous cancer diagnosis does not automatically exclude a potential donor, especially when the malignancy was isolated or successfully treated long ago. A history of cancer in remission, particularly if a significant number of years have passed without recurrence, often allows for organ donation. The time required for a “cancer-free interval” varies based on the type of cancer and its original stage.
Certain types of localized or low-risk cancers are acceptable for organ donation. Non-melanoma skin cancers, such as basal cell carcinoma or squamous cell carcinoma, are often deemed acceptable because they rarely spread to other organs. Similarly, small, localized tumors of the kidney or prostate that have been successfully treated may be considered, provided the affected organ is otherwise healthy.
Primary brain tumors that are confined to the central nervous system and do not typically metastasize outside the brain are another common exception. This is because the blood-brain barrier often prevents the tumor cells from entering the general circulation, localizing the risk.
The transplant team conducts a meticulous review of the donor’s entire medical history, including pathology reports and biopsies, to assess the precise viability and risk of each specific organ before a final decision is made.
Different Rules for Tissue Donation
It is important to understand that the criteria for tissue donation are distinctly different from those for solid organs. While solid organs must be transplanted immediately with a blood supply intact, tissues are processed, sterilized, and stored in tissue banks. Tissue donation includes materials like corneas, skin, bone, heart valves, and tendons. The less stringent criteria for tissues are primarily due to the processing methods, which can destroy or remove any residual cancer cells, significantly mitigating the risk of transmission. For example, corneas can often be donated even by individuals with a history of most cancers, except for certain blood cancers or cancers of the eye itself. The ability to process and sterilize these materials makes eligibility much broader for patients with various cancer histories.