Organ Transplants Can Also Transfer Disease

Sixteen years after a Scottish woman was diagnosed with melanoma, the deadly \J cancer was transferred to two more people via the woman's donated kidneys.

That incident and similar ones have resulted in stricter controls in some hospitals for organ transplants.

"It's very worrisome," says Dr. Rona MacKie, senior research fellow at the University of Glasgow in Scotland. "The amazing thing about this patient is the gap between having the melanoma diagnosed and giving her kidneys."

The time gap was twice as long as any other case, which testifies to the resilience of tumor cells in the bloodstream, MacKie says.

Although other cancers have been transferred with a transplanted organ, melanoma seems to be particularly dangerous.

"There is a significant risk in patients with melanoma, even after 10 or 15 years. It's not the same with other cancers," says Dr. Robert Fisher, director of liver transplantation and transplantation research at Virginia Commonwealth University Medical Center.

People who have had invasive melanoma should not donate organs. In fact, they are already prohibited from donating blood, according to the American Red Cross.

And although the transplant surgeons should have checked the Scottish woman's background, they could not reach her primary care physician.

THE TRANSPLANTS

In May 1998, a woman in Glasgow finally received the kidney that would enable her to go off dialysis. She seemed well until a year and a half later, when a routine mammography turned up a spot on the woman's left breast.

A biopsy uncovered, something unusual: Secondary melanoma but no primary site. Secondary cancers are those that have spread from another part of the body. MacKie said there was no evidence of a primary melanoma, which is usually attached to a tumor.

Four months later a second transplant patient arrived at the same hospital with a lump in his kidney that turned out-again-to be secondary melanoma with no indication of a primary site. His transplant and the woman's transplant were done only 24 hours apart.

The donor in both cases turned out to be the same person, a 5T-year-old woman who had been treated for melanoma in 1982. After treatment, her doctors considered her cured of the cancer. She died 75 years later, ostensibly of a hemorrhage.

Both kidney recipients had the organs removed and were treated for melanoma, but only one survived.

HOW DID IT HAPPEN?

Although how this happened will never be known because an autopsy was not performed on the donor, two scenarios emerge as possibilities, says Dr. Daniel G. Coit, co-leader of the melanoma disease management team at Memorial Sloan-Kettering Cancer Center in New York City.

One scenario is that the donor actually died of undetected metastatic melanoma. The second is that individual melanoma cells were lurking in her body, waiting for the opportunity to flourish.

MacKie prefers the second scenario, and believes the cancer cells were lying dormant in the kidneys. Because transplant patients take immunosuppressant drugs to minimize the chances that the donated organ will be rejected, the weakened immune system may have encouraged the cancer growth.