I K THOMSON1, J HEDLEY1, B ROSALES1, A WEBSTER1,2
1Centre for Organ Donation Evidence, University Of Sydney School of Public Health, Sydney, Australia, 2Centre for Transplantat and Renal Research, Westmead Hospital, Sydney, Australia
Aim: To describe transmission risk and donation outcomes of donor referrals with PBT, including accuracy of risk assessment at referral, potential missed donor opportunities and transmission events.
Background: Transplantation is often the optimal therapy for end-stage organ disease, including renal failure, but there is a critical shortage of donor organs relative to need. Donor referrals with PBT are frequently considered for donation as risk of transmission is low, however some may be declined due to uncertainty about donor-recipient disease transmission.
Methods: We undertook a population-based cohort study in NSW using the Safety and Biovigilance in Organ Donation public health register of donor referrals 2010-2015. PBT referrals were characterised according to tumour grade and transmission risk, and whether they donated organs. Data linkage was used to determine accuracy of risk assessment at time of referral, and to identify any PBT transmissions.
Results: Of 2957 referrals, 76 (3%) had PBTs. Tumour grade was accurately classified at time of referral in 44 (58%) cases. PBT referrals were younger (50.1 vs. 57.0 years, p=0.002) with fewer comorbidities (1.6 vs. 2.1, p=0.006) than non-PBT referrals. Forty-eight (63%) referrals were declined for donation for reasons unrelated to PBT, 18 (24%) were declined because of perceived PBT transmission risk, and 10 (13%) donated. All PBT donors had WHO-I or -II tumours. Twelve (66%) of 18 declined referrals had WHO-IV glioblastoma multiforme. No transmission occurred after 860 months follow up of 23 transplant recipients of PBT donor organs.
Conclusions: There is opportunity to improve accuracy of donor referral tumour grade classification using integrated datasets. It is reassuring that no PBT transmission occurred. There is evidence of risk aversion to referrals with WHO-IV tumours.
Imogen is a junior doctor and Master of Philosophy candidate at the University of Sydney, with interests in public health and health policy alongside clinical medicine. She is currently working as a management consultant with McKinsey & Company, primarily focusing on the public and social sectors.