What is the risk of cancer transmission with heart transplantation

The organ donor shortage is particularly severe for heart grafts. Donor history of malignancy is a contra-indication for organ donation, but as the heart is an organ at lower risk of metastasis compared to the liver or the lungs, the authors aimed to better determine this risk with heart transplantation (HTx) through an extensive review of the literature.
Results: 7 cases (melanoma, glioblastoma (2), renal carcinoma, choriocarcinoma, hypernephroma, prostate) of transmission of cancer with HTx were reported. All recipients died from transmitted cancer. Interestingly, in 9 other cases, HTx did not induce cancer transmission at long term, despite the evidence of active cancer in the donor proven by autopsy or by cancer transmission in recipients of other organs from the same donor. Reports of UNOS described 274 heart donors with history of various cancers, without transmission to the recipients. In another report, UNOS reported 212 HTx from donor with brain cancer without cancer transmission to the recipients.
Conclusion: HTx is not protected from the risk of donor cancer transmission, but very few cases were reported so far. This fact might indicate that donors with past history of cancer might be considered for heart donation in selected cases, considering the actual organ donor shortage.