Occult donor metastatic adenocarcinoma. Contribution of the forensic autopsy. A case report

BACKGROUND: The transmission of malignancies from the organ donor to the recipients is an uncommon complication, but it can be fatal. Older donors may increase the risk of tumor transmission. A forensic autopsy will help identify diseases that might be transmitted to the recipient. CASE REPORT: Donor was a 75-year-old man with traumatic brain injury caused by an accidental fall, which led to brain death. He had no previous cancer history. The forensic autopsy conducted on the following day revealed a suspicious spot in the lung, on which a biopsy was done. Histological examination confirmed the presence of a metastatic adenocarcinoma in the lung 7 days after both kidneys had been transplanted. After notifying the transplant team, both recipients underwent an early transplant nephrectomy. 15 months later, no signs of malignancy have been detected in the recipients and so they have received a new transplant. CONCLUSIONS: Conducting a forensic autopsy on donors deceased as a result of a fatality offers an additional opportunity to detect previously undiagnosed malignancies. Any suspicious lesion found that could compromise transplant viability should be notified to the transplant team notwithstanding the pathologist's legal requirements. This case shows the need for an exhaustive donor evaluation, including, in selected cases, the performance of an autopsy.