Bierman1 addresses an infrequent but extremely challenging situation that a practicing oncologist may encounter: consultation on a patient with a history of cancer being evaluated for organ transplantation. Patients with a history of cancer have often been deemed not eligible for organ transplantation, primarily because of the perceived increased risk of recurrence and increased morbidity and mortality associated with chronic immunosuppression. 

There is the additional caveat of allocation of limited treatment resources, that is, organ availability. In the United States, over 120,000 patients are on the waiting list for an organ transplantation, with fewer than 40,000 receiving transplantation.2 However, a rational case can be made for some patients with a history of cancer being good candidates for organ transplantation. The biggest challenge is lack of evidence to guide one’s decision. Most of the guidelines in place today were established decades ago and are based solely on expert opinion and are agnostic to the type of cancer. Even the largest transplantation databases lack (1) a sufficient number of organ recipients with a history of cancer, especially cancer survivors of more recent treatment approaches; and (2) specific data on histology, stage, previous treatment, or even organ type of cancer. 

In the article a great job is done in  reviewing existing data and guidelines and discussing caveats.