MELANOMA IN SOLID ORGAN DONORS AND TRANSPLANT RECIPIENTS: TRANSMISSION RISK AND MISSED OPPORTUNITIES

B Rosales1, N De La Mata1, C Vadjic2, J Thomson3, P Kelly1, K Wyburn1,4, A Webster1,5 

1The University Of Sydney, Faculty of Medicine and Health, Camperdown, Australia, 2University of New South Wales, Centre for Big Data Research in Health, Kensington, Australia, 3Melanoma Institute Australia, Wollstonecraft, Australia, 4Royal Prince Alfred Hospital, Department of Renal Medicine, Camperdown, Australia, 5Westmead Hospital, Centre of Transplant and Renal Research, Westmead, Australia 

Aim: We sought to 1) assess agreement between suspected transmission risk when potential donors are considered and verified risk from their cancer records, 2) identify missed opportunities for donation, and 3) estimate melanoma transmission risk in organ donation. 

Background: Biovigilance concerns are in tension with the need to increase solid organ donation. Misclassification of melanoma transmission risk when potential donors are considered, may lead to missed opportunities in organ donation or harm. Melanoma transmission risk may be overestimated as non-transmission events are rarely reported. 

Methods: Potential donors, actual deceased donors, and living donors in NSW, 2000-2013, were linked with the NSW Central Cancer Registry (CCR), 1976-2013. We compared suspected melanoma in potential donors with verified melanoma notifications in CCR and cross-tabulated against donation outcomes. We identified actual donors and recipients with verified melanoma and investigated the possibility of transmission case-by-case, classified as per NOTIFY guidelines. Melanoma (C43) and melanoma in-situ (D03) were identified using ICD-10-AM. 

Results: Of 1,691 potential deceased donors, 15(<1%) had suspected melanoma. Of these, 11/15(73%) were registered as melanomas in CCR, two proceeded to donation. 4/15(27%) had no matching CCR record, of which two were declined for their suspected melanoma risk alone. Additionally, 11 potential donors with known low-risk melanomas, in-situ or localised melanoma, <1.0mm thickness, were declined for donation. Acceptance of these donors would have increased the donor pool by 3%. Of 1,637 actual donors, 13 had a verified melanoma. They donated to 15 transplant recipients. No transmission events were identified. Actual donor melanomas were majority (8/13,62%) low-risk of transmission. 

Conclusions: Including CCR records in deceased donor assessment will aid in melanoma risk classification and identify more opportunities for donation. 


Biography: 

Brenda is currently completing a PhD at The University of Sydney and has a Master in Public Health and Bachelor of Medical Science/Bachelor of Arts in International Studies. She brings together her expertise in cancer research and kidney transplantation in her research. Her work uses data-linkage of routinely collected administrative health data and clinical data to investigate the impact of cancer in people with kidney failure.

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