Résumé
Potential donors for transplantation are screened for malignancies that can be transmitted on to the recipient. The discovery of cancer or a history of cancer often leads to contraindications for organ donation, while in some cases the cancer transmission risk is very low. The current context of organ shortage leads us to reconsider the use of organs from donors with cancer or a history of cancer when the risk of transmission is minimal or less than the risk of death on the waiting list. The Transplantation Committee (CTAFU) in partnership with the Cancer Committee (CCAFU) of the Association Française d'Urology (AFU) were asked to publish guidelines for clinical practice concerning the use of donors with cancer or a history of urological cancer (prostate cancer, kidney cancer, urothelial tumors, testicular cancer).
A review of the literature with a systematic approach (PubMed/Medline) was conducted by a steering group of CTAFU members concerning the assessment of the urologic cancer transmission risk from the donor to the recipient. The conclusions of the supporting evidence were discussed by a working group composed by members of the CTAFU and the CCAFU, who then developed clinical guidelines.
The risk of transmitting prostate cancer is very low. The working group has identified several situations for which organ donation can be done without risk, in particular for low-risk prostate tumors, other situations that require consultation and expertise, and higher-risk cases where transplantation is not recommended. In donors with history of treated kidney cancer, organ removal is not contraindicated for low-grade pT1 tumors. Several conditions are necessary for other stages and grades depending on the time to remission. In case of incidental finding of a kidney tumor during the donor screening, the use of the organs depends on the stage of the tumor, the possibility of ex vivo partial nephrectomy and the possibility to have a quick and reliable histologic examination. Urothelial carcinomas are much more at risk of transmission, and it is not recommended to transplant an organ from a donor with a bladder tumor or upper urinary tract tumor. Recommendations were made for donors with a history of urothelial carcinoma based on the group risk of recurrence. Similarly, the discovery of a testicular tumor in the donor contraindicates the use of organs. Donors with a history of treated stage I testicular cancer may be accepted under certain conditions, as well as stage II and III donors who have been in remission for more than 10years.
The use of donors with a tumor or a history of urological tumor may be considered and should allow the pool of potential donors to be expanded. Guidelines have been established not to lose healthy organs, without compromising the safety of the recipient.