Donating the Gift of Life

Kevin Lewis has donated blood most of his adult life, but it took a friend with a rare blood disorder to show him just how lifesaving all those pints could be. At the time, he was in his 40s and pastor of a small rural church in his hometown of Bristol, Texas. One of his congregants developed a condition that left her body unable to produce enough red blood cells. She could not survive without transfusions every six months.

“Of all the medical advances, blood is the only one they can’t create in any way, shape or form,” says Lewis, now 51. “They can just about rebuild you from top to bottom, but they can’t replicate blood.” He set up regular appointments with Carter BloodCare, his local blood bank, to donate about every eight weeks. He continued the practice long after the woman had passed away.

But those donations abruptly halted in 2006, when doctors discovered melanoma on the side of Lewis’ face. The bean-sized lesion was successfully removed, but like most cancer survivors, Lewis thought his days as a blood donor had ended—that is, until he received a letter from blood center officials in 2009 telling him he could rejoin their ranks.

In much of the world, cancer survivors are universally excluded from donating blood or any tissue as a matter of extreme caution. But as the population ages, waiting lists for organs grow long and blood supplies are often in danger of running low, scientists are turning more attention to donors who might once have been categorically rejected. Research has found that many cancer survivors once denied are actually able to donate, and like Kevin Lewis, can do so sooner after their recovery than once thought.

Not too long ago, Lewis would have been barred from donating blood for five years after his cancer was gone. But Carter BloodCare changed the length of its deferral from five years to two in 2009, after concluding that such a long waiting period wasn’t necessary. “The medical department here took a very detailed look at what has been published in the literature,” says Jeanie Chiu, who serves as medical director of technical services at Carter. “There has never been a documented case of a solid organ cancer being transmitted through a blood transfusion.”

We get a lot of inquiries from former cancer patients. They are eager to give back to the community that was there for them in need.

As knowledge continues to evolve, few rules for donation are permanent or broadly applied, and probably will not be, experts say, with the exception of banning blood donations from people who have had Kaposi sarcoma or a blood cell cancer, such as leukemia or lymphoma. The guidelines for donating organs are even more complex than those for blood, because eligibility depends on so many variables, including the type of cancer a person had, the time since diagnosis, the stage and the kind of treatment used.

Research into blood and tissue donations stands to not only answer questions that could benefit recipients but also appeals to the altruistic tendencies of donors as well. “We get a lot of inquiries from former cancer patients,” says Chiu. “They are eager to give back to the community that was there for them in need.” At least 700 former patients have reentered the donor system at Carter since 2009, most of whom have successfully conquered prostate cancer, melanoma and breast cancer. “I’m extremely grateful for the fact that I’ve been cancer-free,” Lewis says. “I’m happy to be able to supply blood to the people who need it.”

[While going through treatment, did family and friends donate blood or platelets for you? Do you hope to return the favor one day?]

The criteria for blood donation varies from center to center, and even patient to patient, so the only sure way to know if you qualify is to call your local blood bank and ask. Donors who have solid tumors can usually donate corneas—and about 18.5 percent of donations to eye banks in the U.S. come from people with a history of cancer, according to the Eye Bank Association of America. As with other tissue donations, however, people with leukemia, lymphoma and myeloma are excluded. For organ donation, decisions are often made at the time an organ becomes available and are based on the health status of both donor and recipient. “There are not good guidelines because there are not a lot of data,” says Thomas Gross, a pediatric hematologist and oncologist, and chief of the transplant program at Nationwide Children’s Hospital in Columbus, Ohio. “Certainly there are cases of cancer transmitted through donated organs. Most of the time when that was found to be the case, the cancer was not known to the donor.”

Cancer can be transmitted when a donated organ contains the seeds of cancer that remained undetected while the donor was alive. Doctors also have concerns about whether tumor cells circulating in the blood might have lodged silently in a donated organ. Once organs are transplanted, a recipient would be extremely vulnerable to undiscovered cancer cells because immunosuppression, which could impair the ability to destroy microscopic cancer, is part of organ transplantation.

The risks are more than theoretical, and, while rare, cases of donor-transmitted cancer have occurred. As a result, doctors have traditionally been very wary about the idea of transplanting donated organs from cancer survivors, researchers in Britain pointed out in 2011 in an editorial in the American Journal of Transplantation. However, “given the severe shortage of organs for transplantation, such a cautious approach may no longer be appropriate, at least not in all cases. There is an increasing need to balance the risk of using organs from donors where there may be a low or even intermediate risk of disease transmission, against the likelihood of death on the transplant waiting list.”

Here’s one perspective: In 2005, experts reviewed data from the Organ Procurement and Transplantation Network/United Network for Organ Sharing (the organization that manages the country’s organ transplantation system) during 2000 to 2005 and reported that out of 175 recipients of organs from patients with a history of grade 4 gliomas, only one donor transmitted a malignancy to three recipients, a 1.7 percent incidence of transmission. During the same time, almost 40,000 people died waiting for a new organ. One of the most recent studies to examine the risk of cancer transmission from organ donation was published in the American Journal of Transplantation in 2011. Experts found great variability in the risk. Some tumors, such as single, small thyroid tumors or kidney tumors that were small and could be surgically removed, were classified as minimal or low risk. But others, such as lung cancer or any kind of metastatic cancer were deemed highly risky for transplantation.

A clearer pattern has emerged for blood donors. In 2010, researchers from Australia reviewed available data about whether cancer had been transmitted through a transfusion. The reason for the study, they said, was because many parts of the world permanently exclude anyone with a history of cancer, regardless of severity or years they’ve been cancer-free, from donating blood. “Yet after nearly a century of blood banking, there have still been no convincing reports of a malignancy transmitted from donor to recipient via blood transfusion,” they wrote in Transfusion Medicine Reviews.

“When you think about it, it makes sense,” says Lillie Shockney, a registered nurse and administrative director of the Johns Hopkins Avon Foundation Breast Center in Baltimore. Blood recipients are more likely to have immune systems that could fight any stray cancer cells. “Let’s say a blood donation did have circulating cancer cells in it. They would be considered foreign to the recipient. The T cells in the recipient should find them and kill them.”

Shockney’s institution participated in the Rapid Tissue Harvest Program, a three-year study in which 20 women with metastatic breast cancer agreed to have all their organs—cancerous and noncancerous—harvested shortly after death so scientists could examine them in an attempt to understand how their cancer grew and spread. “If breast cancer never left the breast, no one would ever die of this disease,” she says.

Knowledge from that study and others may one day clear more cancer survivors for blood and tissue donation. Meanwhile, says Kevin Lewis, “don’t let cancer stop your ability to help other people. Obviously some cancers will defer you, but they are doing more and more research. I was told at first I would be deferred indefinitely. Don’t give up on it.”