Brain Tumor Patients with Uncertain Metastatic Potential as Organ Donors in Infancy and Childhood

Dear Editors,

I read with interest the case report of JW Rey et al. [1] of a pediatric organ donor with a brain tumor who did not transmit tumor in the donated organs. Although the tumor type was not identified despite gross total tumor resection having been achieved, the cerebellar hemispheric location in this age group suggests a pilocytic astrocytoma or primitive neuroectodermal tumor. The authors concluded based upon their experience and analyses of two large registries that brain tumor patients should not be excluded as organ donors but that high-risk donors such as patients with VP shunts should be excluded.

We have previously reviewed the topic of brain tumor patients as organ donors and note that the literature does not support the notion that factors like a history of ventriculoperitoneal (VP) shunt or craniotomy identify donors as high risk versus low risk [2]. Specifically, bone metastases occasionally develop in medulloblastoma, and VP shunts do not appear to be a risk factor for development of bone metastases in these patients [3]. A large series found that only 1/4 –1/3 of children with extraneural metastases from medulloblastoma had undergone shunting [4], and subsequent series confirm that CSF shunts do not predispose pediatric brain tumor patients to develop extraneural metastases [5].

Several recent case reports highlight the potential of developing glioblastoma in a transplanted organ [6] [7] [8]. In contrast to the often promulgated dictum that surgical breach of the blood-brain barrier is required to put a donor at risk of transmitting a primary brain tumor, none of the three patients reported had undergone craniotomy. One had a stereotactic biopsy [6], while the other two had no neurosurgical procedures [7] [8]. In summary, the issue of suitability of brain tumor patients as organ donors remains unsettled. However, one should not rely on unvalidated and likely incorrect criteria to draw confidence that a given donor is low-risk.

D. Schiff

References

• 1 Rey1  JW, Heister1  P, Wirges1  U. et al . Organ donor with unclear primary brain tumor, a contraindication for transplantation? Case report of an one year old child.  Klin Padiatr. 2009;  221 390-392
• 2 Cavaliere R, Schiff D. Donor transmission of primary brain tumors: A neurooncologic perspective.  Transplantation Reviews. 2004;  18 204-213
• 3 Wendland MM, Shrieve DC, Watson GA. et al . Extraneural metastatic medulloblastoma in an adult.  J Neurooncol. 2006;  78 191-196
• 4 Hoffman HJ, Duffner PK. Extraneural metastases of central nervous system tumors.  Cancer. 1985;  56 1778-1782
• 5 Berger MS, Baumeister B, Geyer JR. et al . The risks of metastases from shunting in children with primary central nervous system tumors.  J Neurosurg. 1991;  74 872-877
• 6 Armanios MY, Grossman SA, Yang SC. et al . Transmission of glioblastoma multiforme following bilateral lung transplantation from an affected donor: case study and review of the literature.  Neuro Oncol. 2004;  6 259-263
• 7 Fatt MA, Horton KM, Fishman EK. Transmission of metastatic glioblastoma multiforme from donor to lung transplant recipient.  J Comput Assist Tomogr. 2008;  32 407-409
• 8 Chen H, Shah AS, Girgis RE. et al . Transmission of glioblastoma multiforme after bilateral lung transplantation.  J Clin Oncol. 2008;  26 3284-3285