Turra Vitor, Manzi Joao, Rombach Sarah, Zaragoza Simone, Ferreira Raphaella, Guerra Giselle, Conzen Kendra, Nydam Trevor, Livingstone Alan, Vianna Rodrigo, Abreu Phillipe
Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, FL, United States.
HCA Healthcare-HealthOne Internal Medicine Residency Program, Sky Ridge Medical Center, Denver, CO, United States.
Transpl Int. 2025 Jan 24;38:13716. doi: 10.3389/ti.2025.13716. eCollection 2025.
The growing number of organ donors in the United States, from 14,011 in 2012 to 21,374 in 2022, highlights progress in addressing the critical issue of organ shortages. However, the demand remains high, with 17 patients dying daily while on the waiting list. As of August 2023, over 103,544 individuals are awaiting transplants, predominantly for kidneys (85.7%). To expand the donor pool, the inclusion of elderly donors, including those with a history of malignancies, is increasingly considered. In 2022, 7% of all donors were aged 65 and above, despite the complexities their medical histories may introduce, particularly the risk of donor-transmitted cancer (DTC). This review examines the challenges and potential benefits of using donors with known malignancy histories, balancing the risks of DTC against the urgency for transplants. A critical analysis is presented on current knowledge and the decision-making processes that consider cancer types, stages, and patient survival outcomes. The goal is to identify missed opportunities and improve strategies for safe and effective organ transplantation from this donor demographic.
美国器官捐献者数量不断增加，从2012年的14,011人增至2022年的21,374人，这凸显了在解决器官短缺这一关键问题上所取得的进展。然而，需求仍然很高，每天有17名患者在等待名单上死亡。截至2023年8月，超过103,544人正在等待移植，主要是肾脏移植（85.7%）。为了扩大捐献者群体，越来越多的人考虑纳入老年捐献者，包括有恶性肿瘤病史的人。2022年，所有捐献者中有7%的年龄在65岁及以上，尽管他们的病史可能带来复杂性，特别是供体传播癌症（DTC）的风险。本综述探讨了使用有已知恶性肿瘤病史的捐献者所面临的挑战和潜在益处，权衡DTC的风险与移植紧迫性。对当前知识以及考虑癌症类型、阶段和患者生存结果的决策过程进行了批判性分析。目标是识别错失的机会，并改进从这一捐献者群体进行安全有效器官移植的策略。
