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Summary With the more frequent use of organs from elderly donors, the risk of transmitting tumor cells to the recipient increases. We report a case in which anaplastic carcinoma tumor cells from an organ‐donor were transmitted to a kidney transplantation recipient. The donor's metastatic disease was discovered 7 days after harvest of the kidney following a brain biopsy undertaken at admission of the donor. The risk of transmitting the disease was generally estimated as so small that the excellently functioning kidney was not removed. Twelve weeks later, however, malignant cells were found in a biopsy of the transplanted kidney. The organ was removed immediately, but the intraoperative situs showed advanced disease with lymph‐node‐metastasis. Twelve months later no tumor progress could be detected. This case shows that there is considerable risk of transmitting formerly undetected cancer in elderly donors. Autopsies of donors who are older than 60 years of age should be routinely performed after organ donation.

Surgical problems during organ procurement may propagate complications in the transplant recipient. Ultimately, these problems may result in the complete loss of already scarce donor organs.Donor reports (Eurotransplant donor report) of 1,492 donor organs from January 2010 to August 2012 in the German Foundation of Organ Transplantation (DSO) region of Bavaria and corresponding organ quality forms were analyzed. Surgical problems were classified into 3 categories: (I) surgical problems recognized and reported by the donor surgeon, (II) surgical problems observed by the recipient surgeon but not reported by the donor surgeon and (III) surgical problems leading to organ loss. Surgical problems during this 20-month time period were reported for 17.6  % of organs; category I in 5.5  %, category II in 11.1  % and category III in 1  %. Damage of graft vasculature in 9.1  % was the most frequently reported problem. The mean error index for individual surgeons was 16  % and one out of the five Bavarian organ procurement centers had significantly more problems in all categories (30  %). Interestingly, surgeons who performed rapid retrieval procedures had more problems with quality than surgeons who took more time. Organ retrieval is prone to surgical problems. Especially in a system of organ transport, consistent reporting of surgical problems and quality assurance is needed to maintain and to improve surgical quality.

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