Malignancy in the brain-dead organ donor

The ongoing shortage of organ donors requires meticulous evaluation of all potential organ offers so as to maximize use of these lifesaving gifts. Such efforts must be counterbalanced by equal concerns for recipient safety. An important aspect of this process includes minimizing the possibility that unsuspected donor disease, including cancer, may be transmitted to the recipient. In this chapter, we discuss donor cancer and place it into context with current United States Organ Procurement and Transplantation Network (OPTN) policy, current experience, and with efforts to minimize the risk of transmission via transplantation. Current systems to systematize categories of risk transmission are discussed and the use of organs from donors with certain types of tumors is considered. Certain aspects of particular interest in the case of the potential organ donor with brain death will be emphasized.