It’s not uncommon for infectious diseases to pass from donors to recipients during organ transplantation, but in an extraordinarily rare case, four Britons developed breast cancer years after they received organs from the same donor, despite extensive testing, according to a recent medical report.

Three of the recipients died after the cancer spread from the organs to other areas of the body. The donor, a 53-year-old woman who died of a stroke in 2007, had no known illnesses, said the case report, published in April in the American Journal of Transplantation. 

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