Histopathology

All retrieval surgeons of the National Organ Retrieval Service perform an extensive examination of the abdomen and the chest at time of retrieval in order to exclude the presence of malignancies, as it would represent contraindications to organ donation.

Therefore, during the organ retrieval operation it may be possible to observe unexpected and undiagnosed lesions in the donor. The lesions can present themselves as “lumps” or “growth” that were not causing any form of symptoms in the donor. More importantly, these lesions may not have ever been investigated.

In order to proceed with safe transplantation it is of paramount importance to evaluate any abnormality encountered with a biopsy. This consists of taking a sample of the lesion and urgently processing for examination by a Pathologist.

The sample may be “fixed” in a special solution to preserve the sample or sent as “frozen” section. The sample is then prepared for examination under the microscope.

The urgent report of the pathologist will then be made available to the NORS Team and transplant centres.

Urgent biopsies may also be performed for assessing organ quality. When organs are retrieved from certain categories of donors, such as elderly or with complex medical history (eg diabetes, hypertension, alcohol abuse), it may be necessary to evaluate the quality of the specific organ; mostly kidneys and livers may be biopsied.

These biopsies generally take place at the transplant centres and look to confirm the quality of the organ and aid counselling of the recipient accordingly.

It is not uncommon performing these biopsies as with progressive ageing of the population and increasing rate of donation, suspicious lesions are encountered more often. 

Finally, biopsies may be taken for research purposes, only after adequate consent has been taken.

ODT is currently supporting a number of projects aimed to ameliorate the histopathology service nationally for ensuring a safe and high quality transplant practice.