Doctors have reported a case where three patients died from breast cancer which they contracted from a single organ donor, a 53-year old woman with the disease whose kidneys, lungs, liver and heart were transplanted.

After suffering a stroke in 2007 the woman’s organs were donated to five people, but her diagnosis was not known to doctors and four patients contracted aggressive “donor derived” breast cancers.

A fifth recipient died within five months of receiving the heart transplant from sepsis, where the immune system starts attacking the body in response to a foreign organ or other serious infection.

The patients’ cancers were first noticed 16 months after the transplant, though others took as long as six years to spread and be picked up.

Using DNA testing doctors were able to match the genetic profile of the cancer cells in each patient with the original donor demonstrating that it had been cancerous cells in the transplant organs to blame.

Experts said there is approximately a one in 10,000 (0.01 to 0.05 per cent) chance of screening tests which check the suitability of donors failing in this way and transplanting an infected organ.

Under the skin – best of the British Heart Foundation 2018 image prize Show all 10 1 /10 Under the skin – best of the British Heart Foundation 2018 image prize Under the skin – best of the British Heart Foundation 2018 image prize Subarachnoid vessels The runner-up image came from Matt MacGregor Sharp, a PhD student at the University of Southampton. The super-high resolution image shows a normal artery at the surface of a rat’s brain and was taken with a powerful scanning electron microscope. These ‘subarachnoid vessels’ supply blood to the brain and also act like a drain to remove toxic waste products. Matt Macgregor’s team are trying to show that failure to remove waste by these vessels is one of the underlying causes of vascular dementia. The researchers took the image using a technique called ‘freeze fracture’, where tissue or cell samples are frozen and then split apart to reveal the hidden layers within the sample so they can be studied in extreme detail. Sitting above the brown brain tissue, the artery appears blue, and its surrounding layer, the pia mater, is shown in purple. Matt MacGregor Sharp, University of Southampton, British Heart Foundation - Reflections of Research Under the skin – best of the British Heart Foundation 2018 image prize Explosive beginnings Winner: Endothelial cells line all blood vessels in the body, forming a barrier between the circulating blood and the vessel wall. They also help to protect blood vessels from damage and release important chemical messengers which help to control blood pressure. The winning researcher, Courtney Williams, is a Masters student and PhD candidate at Leeds University. Her lab are developing new ways to map the growth of new blood vessels within their surrounding landscape in 3D. Understanding the complex secrets of blood vessel formation could be harnessed to boost the regrowth of damaged blood vessels after a heart attack, and halt blood vessel growth when it’s counterproductive. Courtney Williams, Leeds University, British Heart Foundation - Reflections of Research Under the skin – best of the British Heart Foundation 2018 image prize A snapshot of platelet production - Reflections of Research Supporters’ Favourite This image from Abdullah Obaid Khan, a PhD student at the University of Birmingham, won the supporters’ favourite. What look like precious jewels are actually platelets forming within the bone marrow. Platelets are the smallest of our circulating blood cells with a hugely important role in preventing bleeding. However, they also play a role in the formation of clots, which can lead to heart attacks and strokes. Abdullah Obaid Khan and his team are studying rare bleeding disorders. Abdullah Obaid Khan, University of Birmingham, British Heart Foundation - Reflections of Research Under the skin – best of the British Heart Foundation 2018 image prize Cardiac collagen web - Shortlist This colourful image shows the web-like, network of the smallest blood vessels in the heart – the microvessels. Magenta marks the outer collagen layer of the vessels; while orange marks their inner lining and blue the cell nuclei. Dr Neil Dufton, Imperial College London Dr Neil Dufton, Imperial College London, British Heart Foundation - Reflections of Research Under the skin – best of the British Heart Foundation 2018 image prize Heart to Heart - Shortlist This piece shows four ventricles (from a mouse) arranged into the shape of the hearts four normal chambers. The researchers have used fluorescent markers to recognise certain proteins and created the image using of hundreds of images assembled together. Dr Elisa Avolio and Dr Zexu Dang, University of Bristol Dr Elisa Avolio and Dr Zexu Dang, University of Bristol, British Heart Foundation - Reflections of Research Under the skin – best of the British Heart Foundation 2018 image prize Loving artery - Shortlist This image shows a cross section of an artery and the different layers which make up the artery wall. Affiliate Professor Silvia Lacchini, University of Glasgow Silvia Lacchini, University of Glasgow, British Heart Foundation - Reflections of Research Under the skin – best of the British Heart Foundation 2018 image prize Oxidative inkblot - Shortlist This colour explosion shows one of the culprits in cardiovascular disease – an enzyme called NADPH oxidase. The enzyme is considered ‘Janus faced’ because it is important in health, as well as disease. This picture shows the active enzyme in patients who have high blood pressure. Dr Livia de Lucca Camargo, University of Glasgow Dr Livia de Lucca Camargo, University of Glasgow, British Heart Foundation - Reflections of Research Under the skin – best of the British Heart Foundation 2018 image prize Neon skeleton - Shortlist This image shows the developing blood vessel system of a two day old zebrafish embryo. The researchers used gene enhancers (the on-off switches of genes) to switch on fluorescent markers in different types of endothelial cells – the important cells which line all blood vessels. All blood vessels switch on the red marker, while the veins also switch on the green marker, resulting in yellow veins and red arteries. Dr Svanhild Nornes, University of Oxford Dr Svanhild Nornes, University of Oxford, British Heart Foundation - Reflections of Research Under the skin – best of the British Heart Foundation 2018 image prize Calcium reef - Shortlist This image shows calcium in blood vessel cells from people who have high blood pressure and resembles Australia’s Great Barrier Reef. Dr Rheure Alves-Lopes, University of Glasgow Dr Rheure Alves-Lopes, University of Glasgow, British Heart Foundation - Reflections of Research Under the skin – best of the British Heart Foundation 2018 image prize Budding blood vessels - Shortlist This image shows the growing blood vessels in the mouse retina. In red you can see all the blood vessels and in yellow/green you can see the blood vessels that are actively growing (a process called sprouting). PhD candidate Kira Chouliaras, University of Oxford Kira Chouliaras, University of Oxford, British Heart Foundation - Reflections of Research

Dr Yvette Matser, from VU University Medical Center, The Netherlands, was lead author of the report in the American Journal of Transplantation, which notes: “The extremely low rate of transmission of malignancies during transplantation proves the efficiency of the current guidelines.”

It says using a CT scan to examine deceased potential donors thoroughly is impractical and increases the risk of false positives which would “shrink the already small donor pool”.

A medical exam, including a breast exam, to look for tumours is already recommended and should always be carried out.

In this case it is possible that keeping the donor organs warm allowed cancer cells to circulate more widely, they suggest.

The first patient to fall ill was a 42-year old woman who received a double-lung transplant, but by the time she was diagnosed the condition had already spread (metastasised) to her bones, and she died in 2009.

Doctors warned remaining patients about the risk and the man and woman who each received a kidney from the donor were tested, but only began to show signs of the disease several years later.

A male recipient had his kidney removed after a tumour was detected in 2011, he underwent chemotherapy along with stopping the immune system suppressing drugs taken by transplant recipients and is still cancer free.

The remaining two women, recipients of a kidney and liver, died after their cancers spread.

One of them, a 59-year old woman who received a liver, declined to have it removed when the tumour was first discovered because of fears of further complications.

Transplant recipients take powerful immune system suppressing drugs to prevent their organs being rejected and this can make it more likely that cancer cells are not wiped out.