Expanding the Criteria of Organ Procurement from Donors with Prostate Cancer: The Application of the New Italian Guidelines

• Published in: American journal of transplantation Vol. 10; no. 8; pp. 1907 - 1911
• Main Authors: D’Errico‐Grigioni, A., Fiorentino, M., Vasuri, F., Corti, B., Ridolfi, L., Grigioni, W. F.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.08.2010; Wiley
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Clinical death. Palliative care. Organ gift and preservation; Digital Rectal Examination; Guidelines as Topic; Histopathology; Humans; Italy; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; organ donation; Prostate - pathology; prostate cancer; Prostate-Specific Antigen - analysis; Prostatic Neoplasms - pathology; Referral and Consultation; second opinion expert; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue and Organ Procurement - legislation & jurisprudence; Tissue Donors - supply & distribution; Tumors of the urinary system; Urinary tract. Prostate gland; Italy; Europe; Italian; second opinion expert; Urinary system disease; Prostate disease; Malignant tumor; Recommendation; Organ donation; Histopathology; Donor; Criterion; Organ harvesting; Male genital diseases; Application; Prostate cancer; Cancer; Organ
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2010.03198.x

Prostate cancer (CaP) represents the most prevalent malignancy in men more than 60‐year‐old, posing a problem in organ procurement from elderly subjects. However, most of the currently diagnosed CaP are low‐grade and intraprostatic, with low metastatic risk, and there is recent evidence that most patients are overdiagnosed. The Italian National guidelines about organ acceptance from neoplastic donors changed in March 2005, extending the pool of potential candidates with CaP and introducing the function of a second opinion expert. Between 2001 and February 2005, 40 candidate donors with total PSA≥10 and/or positive digital rectal examination underwent histopathological analysis of the prostate: 15 (37.5%) donors harboured CaP, and 25 (62%) were judged at ‘standard risk’. After the introduction of the new guidelines in 2005, the second opinion expert judged at ‘standard risk’ 48 of 65 donors, while 17 of 65 needed histopathological analysis. Four (6.2%) donors harboured CaP, and 61 (94%) where judged at ‘standard risk’, with a significant increase of donated and actually transplanted organs. The application of the new guidelines and the introduction of a second opinion expert allowed a significant extension of the ‘standard risk’ category also to CaP patients, decreasing the histopathological examinations and expanding the donor pool. Extension of donor pool to elderly subjects with prostate cancer results in significant gain in organ harvesting.