• Donor cancer. Nephrology 2005 Oct;10(S4):S125-8.



• Donor cancer. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2005 Jun. 8 p. [12 references]

This is the current release of the guideline.

• Cancer
• Renal transplantation

Evaluation
Management
Risk Assessment
Treatment

Critical Care
Emergency Medicine
Nephrology
Nursing
Pediatrics
Surgery
Urology

Advanced Practice Nurses
Nurses
Physician Assistants
Physicians

• To provide a practical and applicable protocol, based on the evidence that is available, for the selection of deceased kidney donors
• To provide a practical and applicable protocol, based on the evidence available for the assessment of living donors, prior to kidney donation

Patients awaiting renal transplantation

Evaluation/Risk Assessment

Assessment for exclusion of cancer in potential kidney donors by clinical history and clinical examination

• Donor age <50 years
• Donor age >50 years

Management/Treatment

Donor exclusion for history or presence of cancer with exceptions

• Non-metastatic, non-melanoma skin cancer
• Carcinoma in situ of the cervix
• Other cancers know to have been fully eradicated

• Donor cancer detection rate
• Donor exclusion rate
• Transmission rate of cancer from donor to recipient

Searches of Electronic Databases

Databases searched: Medical Subject Heading (MeSH) terms and text words for kidney transplantation and cadaveric organs were combined with MeSH terms and text words for diabetes, hypertension, viruses, bacterial infections, non-heart beating, marginal donor, paediatric donor, aged donor, and donor with prior cancer. These were then combined with the Cochrane highly sensitive search strategy for randomized controlled trials and search filters for identifying prognosis and aetiology studies. The search was carried out in Medline (1966 – November Week 2 2003). The Cochrane Renal Group Trials Register was also searched for trials not indexed in Medline. A further search was carried out in Medline (January 2004) using the text words donor malignancy, renal transplantation and liver transplantation.

Date of searches: 12 December 2003; January 2004.

Not stated

Weighting According to a Rating Scheme (Scheme Given)

Levels of Evidence

Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)

Level II: Evidence obtained from at least one properly designed RCT

Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group

Level IV: Evidence obtained from case series, either post-test or pretest/post-test

Review of Published Meta-Analyses
Systematic Review with Evidence Tables

Not stated

Expert Consensus

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Comparison with Guidelines from Other Groups
Peer Review

Recommendations of Others. Recommendations regarding use of potential kidney donors with cancer for renal transplantation from the following groups were discussed: Kidney Disease Outcomes Quality Initiative, British Renal Association, European Best Practice Guidelines, The United Network for Organ Sharing, and The British Transplantation Society.

Definitions for the levels of evidence (I–IV) can be found at the end of the "Major Recommendations" field.

Guidelines

No recommendations possible based on Level I or II evidence

Suggestions for Clinical Care

(Suggestions are based on Level III and IV sources)

• Cancer is transmissible through organ donation and the risk of transmission, although in the order of 0.015%, cannot be fully eliminated.
• Deceased and living donors under the age of 50 years should have prior and current cancer excluded by clinical history and clinical examination. Female donors of reproductive age with death due to intra-cerebral haemorrhage should be screened for metastatic choriocarcinoma by testing serum human chorionic gonadotropin β-subunit (β-HCG) concentration. Skin, breast and large colon cancer are the commonest cancers in the general population under 50 years of age and should be specifically considered.
• Deceased and living donors over the age of 50 years should have prior and current cancer excluded by clinical history and clinical examination. Investigations should include Prostate Specific Antigen testing in males. Cancer of the prostate in males, breast in females, large bowel, lung, melanoma, stomach, pancreas, kidney and bladder, lymphoma and leukaemias are the commonest cancers in the general population aged over 50 years, and should be specifically considered.
• A donor will be excluded if they are confirmed or suspected to have, or have had a diagnosis of cancer which may be transmitted to the recipient. Donors and organs should be examined thoroughly at the time of retrieval and frozen sections taken of any suspect lesions. A formal post-mortem is desirable in all cases.
• Exceptions to the above may be made in the case of:
  • Non-metastatic, non-melanoma skin cancer
  • Carcinoma in situ of the cervix
  • Other cancers known to have been fully eradicated from the donor
• Donors with primary intracerebral tumours may be acceptable in the absence of neurosurgical intervention. Specific consent should be sought from the recipient of organs from such donors.

Definitions:

Levels of Evidence

Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)

Level II: Evidence obtained from at least one properly designed RCT

Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group

Level IV: Evidence obtained from case series, either post-test or pretest/post-test

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

• Appropriate assessment and exclusion of potential kidney donors with cancer for renal transplantation
• Prevention of transmission of cancer from kidney donors to renal transplant recipients

Not stated

Tumours with a propensity to late recurrence such as breast cancer, malignant melanoma and sarcomas are an absolute contraindication to organ donation.

Implementation and Audit

The Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and Australia and New Zealand Organ Donation Registry (ANZOD) need to produce maintain an Annual Report of the outcome of all organ donations from donors with a prior history of cancer.

Living with Illness

Effectiveness

• Donor cancer. Nephrology 2005 Oct;10(S4):S125-8.



• Donor cancer. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2005 Jun. 8 p. [12 references]

Not applicable: The guideline was not adapted from another source.

2005 Oct

Caring for Australasians with Renal Impairment - Disease Specific Society

Industry-sponsored funding administered through Kidney Health Australia

Not stated

Authors: David Harris, Convenor (Westmead, New South Wales); Merlin Thomas (Prahran, Victoria); David Johnson (Woolloongabba, Queensland); Kathy Nicholls (Parkville, Victoria); Adrian Gillin (Camperdown, New South Wales)

All guideline writers are required to fill out a declaration of conflict of interest.

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI Institute on April 22, 2008.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.