A medical disaster in Europe has put a spotlight on the small but very serious risks associated with organ transplants.
Four patients in Europe developed breast cancer after they each received a transplanted organ from the same donor.
A case study released by the American College of Transplant Surgeons said this was the first time one donor with undetected cancer managed to transmit the disease to four separate patients.
An Undetectable Disease
The donor, a 53-year-old woman who died in 2007 following a brain bleed, was given the usual battery of tests before her organs were harvested for donation.
At the time, none of the tests showed any sign of malignant tumors, so her kidneys, liver, and lungs were donated to four adult patients.
But each of those patients went on to develop breast cancer as early as 16 months after their transplants.
All of the donor recipients were warned to get tested for cancer after the first case was confirmed, but the other three patients still tested negative.
DNA tests on tissue from the infected organs proved that all four cases of cancer originated with the donor. But doctors say when the organs were donated no trace of cancer could be detected.
Even if it could have, malignant tumors do not restrict a patient from donating organs except for skin and a few other exceptions.
Doctors now believe the donor had "micro metastases" that were simply too small to be spotted by tests, but went on to spread in the recipients' bodies.
A Rare But Deadly Mistake
Cases where donated organ tissue cases cancer are "extremely rare," but not unheard of according to the report's authors.
They say the risk of transmitting cancer from person to person through donation is considered lower than 0.1% - as low as 0.05% for some patients.
That works out to less than one transmitted case per 2,000 transplants.
So the fact that four patients were infected from this single donor makes this a historic case.
Another strange twist is that some patients didn't develop cancer for years after their transplants.
Three of the infected organ recipients ultimately died from their cancer.
The fourth only survived because his transplanted kidney was removed again, and he was taken off the post-transplant medication which suppressed his immune system before undergoing chemotherapy.
The report's authors said that despite this terrible case, "current practices of donor screening for malignancy are effective."
They also shared a warning to transplant doctors that breast examinations should not be overlooked as part of the complete medical examination before a transplant.
More invasive tests - like CT scans - may have spotted the cancer. But doctors worry that adding an extra step to the transplant process would shrink the already-small group of willing organ donors.
The report's authors also proposed that if transplanted organs are found to be infected, removing them quickly should be strongly considered - it just might save a life.
What matters most is that even a medical horror story like this should not scare you away from life-saving transplant surgery.
Dr. Frederike Bemelman, one of the report's authors, says there is "always a small risk" something will go wrong.
"Even if you undergo a simple gallbladder procedure, you also have a small chance of something happening to you during the procedure," she added.
“The advantages of organ transplantation far outweigh these small risks. People should not be worried.”