WEDNESDAY, Feb. 5, 2003 (HealthDayNews) -- It was as if a hand had reached back from the grave, perpetrating a particularly cruel twist of fate on the living.
Sixteen years after a Scottish woman was first diagnosed with melanoma, the deadly cancer was transferred to two more people via the woman's donated kidneys.
"It's very worrisome," says Dr. Rona MacKie, lead author of a letter that appears in the Feb. 6 issue of the New England Journal of Medicine. "The amazing thing about this patient is the gap between having the melanoma diagnosed and giving her kidney."
It was double the length of time of any other case, which testifies to the resilience of tumor cells in the blood stream, MacKie says.
The cascade of events started out hopefully enough. In May 1998, a woman in Glasgow finally received the kidney that would enable her to go off dialysis.
All went well until a year and a half later, when a routine mammography turned up a spot on the woman's left breast. A biopsy uncovered something highly unusual: secondary melanoma, but no primary site. (Secondary cancers are those that have spread from another part of the body. Primary cancers refer to tumors at the original site.)
"We looked carefully for evidence of primary melanoma and didn't find it. I suggested to the renal doctors that it was possible this melanoma could have been in the transplanted kidney, but they were quite sure that was quite impossible," MacKie says.
Four months later, a second transplant patient arrived at the same hospital with a lump in his kidney that turned out -- again -- to be secondary melanoma with no indication of a primary site.
"What I found interesting was the dates of the transplants," MacKie recalls. "They were 24 hours apart."
The donor in both cases turned out to be the same person, a 62-year-old woman who had been treated for melanoma in 1982. When she died, 16 years later, ostensibly of a hemorrhage, her doctors had considered her cured.
While both kidney recipients had the organs removed and were treated for melanoma, only one survived.
How did this happen?
While the absolute reason will never be known because an autopsy was not performed on the donor, two scenarios emerge as possibilities, says Dr. Daniel Coit, chief of gastric and mixed tumor service at Memorial Sloan Kettering Cancer Center in New York City.
One is that the donor actually died of undetected metastatic melanoma. The second is that individual melanoma cells were lurking in her body, waiting for the opportunity to flourish.
MacKie prefers the second scenario.
"I think the cells were lying dormant in these two kidneys," she says. "As long as the patient has a normal immune system, the immune system copes and keeps them under control. Then you have a changed situation where they're put into other recipients who are required to have their immune system damped down. This allows the tumor to grow out."
All transplant recipients take immunosuppressant drugs to minimize the chances that the donated organ will be rejected.
It's an odd case, but not entirely without precedent, Coit says.
Eight or 10 years ago, Coit recalls, the heart of a young man who had been killed in a motorcycle accident was donated. An autopsy performed after the transplant showed that the donor had metastatic melanoma. By this time, though, it was too late. The recipient died of metastatic melanoma as well.
"Melanoma is easily transplantable," Coit says.
In another case, a lab technician stabbed her finger with a piece of glass that had been in contact with melanoma tissue. She developed a tumor on her finger. It was removed and she recovered, Coit says.
Although cancers have been transferred with a transplanted organ, melanoma seems to be particularly dangerous.
"There is a significant risk in patients with melanoma even after 10 or 15 years. It's not the same with other cancers," say Dr. Robert Fisher, professor of surgery and director of liver transplantation and transplantation research at Virginia Commonwealth University Medical Center.
"Melanoma is a very, very, very problematic cancer in that it can actually be like a hidden reservoir," Fisher adds. "At least in our practice, we have always considered melanoma to be a bad actor."
The moral of the story: People who have had invasive melanoma should not donate organs, the study says. In fact, they are already prohibited from donating blood, according to the American Red Cross.
And while the transplant surgeons should have checked the Scottish woman's background, she died on a weekend and her primary care physician couldn't be reached.
"They had to do it quickly. It was a question of time," MacKie says. "We now have a rule in Glasgow that for all patients who are possible donors, the general practitioner has to be consulted."
More information
For more on melanoma, visit the American Academy of Dermatology. The U.S. Department of Health and Human Services and TransWeb have information on organ donation.
