69-Year-Old Dies in Rare Case of Catching Aggressive Liver and Lung Cancer From Organ Donor

A 69-year-old man from Arizona tragically died after developing an aggressive form of cancer from a liver transplant, a rare complication that highlights an unexpected risk in organ donation.

The patient, who had initially undergone the transplant to treat cirrhosis and liver cancer, succumbed to the disease approximately six months after receiving the organ.

The transplant procedure, conducted in 2019 at the Mayo Clinic in Phoenix, was initially deemed successful. However, subsequent tests revealed that the new cancer was distinctly different from the hepatocellular carcinoma (HCC) that had necessitated the liver transplant.

Doctors determined that the cancer had originated from the deceased donor, a startling discovery that underscores the complexities of donor screening.

Donor-Derived Cancer: A Rare and Lethal Threat

The patient's ordeal began when an ultrasound performed four months after the transplant uncovered two suspicious masses in the transplanted liver. These findings were later confirmed to be poorly differentiated carcinoma, an advanced and aggressive form of cancer.

While the patient was eventually diagnosed with lung cancer, the tumours remained confined to the transplanted liver, making this an extremely rare case of donor-derived cancer.

According to the patient's case report published in The Oncologist, this is the only known instance of lung cancer being transmitted via a liver graft from a donor without a known history of malignancy.

Such cases are exceedingly rare, and reliable statistics on their prevalence are unavailable. Medical literature includes only sporadic reports of cancer transmission through organ donation.

The Donor's Medical History

The liver donor was a 50-year-old male with no documented history of cancer. Despite undergoing rigorous pre-donation screening, which included detailed examinations of the donor's lungs, no abnormalities or signs of malignancy were detected.

However, further investigation revealed that the donor had been a smoker, and doctors suspect this may have contributed to the undiagnosed lung cancer.

"The features of the tumour were distinctly different from those of the prior HCC," the report noted. Polymerase chain reaction (PCR) testing confirmed that the metastatic carcinoma originated from the donor.

The findings suggest that the donor's cancer had spread to the liver before the organ was transplanted, remaining undetected during pre-donation evaluations.

Challenges in Screening and Detection

The case highlights the inherent limitations of current donor screening protocols. Despite advancements in medical imaging and testing, some cancers may remain undiagnosed, especially in donors without a known history of malignancy.

According to a 2013 review in Cold Spring Harbor Perspectives in Medicine, the risk of transmitting cancer through organ transplantation is so low that it is primarily documented in sporadic case reports. The review further stated that definitive risk calculations are impossible due to the rarity and variability of such cases.

A 1993 review analysing data from the 1970s similarly concluded that reports of cancer transmission via organ donation are exceedingly rare. While these occurrences are infrequent, they pose a significant challenge for transplant teams aiming to balance the need for life-saving organs with potential risks.

The Patient's Final Months

The patient's initial diagnosis of alcoholic cirrhosis had progressed to HCC, necessitating the liver transplant. After the transplant, the discovery of the tumours in the new liver marked the beginning of an aggressive cancer progression.

Despite undergoing chemotherapy, the patient's condition continued to deteriorate. Reduced immunosuppressive medication, which is essential to prevent organ rejection, compounded the complications.

Doctors noted in the case report: "Progression of [liver] metastases and reduced immunosuppressive agents led to liver failure and the patient's death." The patient's battle underscores the delicate balance between managing cancer treatment and maintaining transplant success.

Implications for Transplant Medicine

This rare case raises critical questions about donor screening and post-transplant monitoring. While the risk of cancer transmission remains minimal, the consequences can be devastating.

Transplant teams may need to consider additional measures, particularly for donors with risk factors such as smoking, even in the absence of overt malignancy.

As medical professionals continue to refine transplant protocols, the case serves as a sobering reminder of the unpredictable challenges faced by both recipients and healthcare providers. For the patient and his family, the promise of a new lease on life through transplantation ended in an unimaginable tragedy