Clinically undetected malignancies in deceased organ and tissue donors: solid organ recipient outcomes and cryopreserved tissue discard

Introduction Unexpected donor malignancy creates uncertainty for solid organ recipients and affects tissue release decisions. Methods We retrospectively reviewed two tissue donor cohorts in Czechia during 2021–2025: 78 vascular and 57 musculoskeletal donors, with one donor contributing to both cohorts, giving 134 unique donors. Results and Discussion Malignancy was identified in 1/78 vascular donors (1.28%; pancreatic adenocarcinoma) and 3/57 musculoskeletal donors (5.26%; two prostate adenocarcinomas and one papillary thyroid carcinoma). Pancreatic cancer was diagnosed on definitive sections from an intraoperative biopsy; the other cancers were identified at autopsy. Three affected donors provided six kidneys and one liver to seven recipients. Transplant-center reports of routine clinical follow-up documented no donor-transmitted malignancy during 14–39 months of available follow-up. Six recipients were alive with functioning grafts; one kidney recipient died from sepsis at 14 months. No tissue from the four affected donors was released for clinical use: 14 processed grafts and 19 unprocessed tissue collections were discarded. Histopathology detected the donor cancers; quarantine and final release checks within the quality management system (QMS) prevented tissue release in all four cases. These observations do not establish equivalent transmission risks across tumor types, exclude later transmission, or quantify the sensitivity or overall effectiveness of the QMS.