Donación de órganos en pacientes con tumor maligno primario cerebralposibles donantes en la Región de Murcia. Análisis de los registros internacionales y nacionales

Abstract

Introduction: Traditionally, organs from patients who actively have, or have been treated for, a malignant disease are not routinely considered candidates for the donation process, even when there is no evidence of metastasis. Currently, donation in these patients is highly regulated by the different international guidelines, differentiating and classifying the risks of transmission according to the primary tumor and stage of the disease. A particular case is that of patients with oncological disease of the central nervous system (CNS), who have been used occasionally, especially those with low-grade tumors, and for whom there is prior experience in organ donation. A low rate of extracranial metastases has been observed in patients with primary malignant brain tumors, which could make the risk acceptable in certain circumstances. Every year patients die in the Region of Murcia due to malignant tumors of the CNS who could be potential donors and who are currently not offered this possibility of donation: if we attend to possible recipients who die without receiving an organ, the inclusion of some of these patients as donors could be an effective and feasible solution, which could lead to the reduction of waiting lists, and decrease the mortality of some recipients, which are more and more numerous. Main objectives: To evaluate and analyze the published literature and the international registries of donors with a malignant primary tumor of the CNS, with the aim of estimating the reliable and approximate risk of transmissibility in donors with a malignant primary tumor of the CNS. To study the number of patients who died in the last 10 years in the region of Murcia with a CNS tumor and therefore estimate the potential for donation in these 10 years. Secondary objectives: To analyze the individualized risk of transmission for each type of organ transplanted from donors with a malignant primary tumor of the CNS. Identify the appropriate organ and recipient for this type of donor. Establish guidelines for action with donors with a malignant primary tumor of the CNS. Material and methods: We have carried out a study that has been divided into 2 phases. Regarding the study of deceased patients, an analytical, retrospective, non-randomized, single-center observational study was designed. Regarding the bibliographic review, a detailed, selective and critical study of the literature was carried out. A search of the literature up to January 2022 was conducted to identify any studies documenting the donation of a patient with malignant brain neoplasia, whether or not the disease was transmitted to the recipient. The European transplant guidelines and the American transplant guidelines were also analyzed. Regarding the study of patients who died in the region of Murcia, the population of our study includes all patients with brain tumors, who died due to progression of the oncological disease or any other cause, between 1/1/2011 and 6/30/2021. Results: Regarding the part of the population that died in the region of Murcia with a primary brain tumor in the last 10 years, 667 patients who met the inclusion criteria for the proposed study were obtained. Regarding age distribution, there were 151 deceased patients under 50 years of age, which represents 22 % of the total sample. In relation to the bibliographic search, 2 cases of transmission of the donor's primary cerebral oncological disease were obtained within the different international registries and 5 clinical cases of transmission not associated with registries. Conclusions: The transmission rate of donors with malignant primary brain tumor could be estimated to be <1 % and therefore these donors could be considered low risk. However, it cannot be rigorously established with the data published in the literature, so it would be more appropriate to treat them as of undetermined risk. In our community, about 15 patients die a year with a primary brain tumor under the age of 50 who could be systematically offered the possibility of donating. Heart transplantation with organs from donors with malignant primary brain tumor can be considered safe, practically allowing self-sufficiency for heart transplantation. For the rest of the organs, the risk-benefit balance would have to be studied individually according to the situation of the recipient, considering patients with code 0 and patients with hepatocarcinoma as the most suitable patients. With regard to kidney donation, actions should be carried out with shared decision-making between the healthcare team and the recipient. It is necessary to establish a clinical guide for safe and viable action with these patients, with an active search by the coordination and the services involved, with a view to donation and monitoring of recipients.