Screening Of Donor And Candidate Prior To Solid Organ Transplantation

Bacterial infections of the respiratory tract, urinary tract, bloodstream infection, or the organ to be transplanted should have documented appropriate treatment with evidence of infection control prior to donation. (Low, Strong)

If a deceased donor is determined to have active bacterial infection based on cultures obtained at the time of procurement, antibiotics should be administered to each recipient for at least 14 days for infections with Gram‐negative bacilli or Staphylococcus aureus. (Low, Strong)

A shorter course of therapy may be considered for less virulent organisms. (Low, Weak)

Recipient of an allograft from a deceased donor with non‐bacteremic, localized infection not involving the transplanted organ does not require treatment, with the exception of meningitis, in which occult bacteremia frequently occurs. (Moderate, Strong)

For potential lung donors, bronchoscopy with cultures should be performed and appropriate antibiotics initiated in the recipient to cover recovered bacteria. (Low, Strong)

Syphilis has rarely been transmitted by transplantation, but it is not a contraindication to deceased organ donation if the recipient is treated post‐transplant with an appropriate course of penicillin. (Low, Strong)

Donors in whom active tuberculosis is a clinical possibility should not be utilized. (Moderate, Strong)

Potential living donors should have PPD testing performed (a two-stage tuberculin skin test if from an endemic area) or IGRA testing; if either test is positive, chest radiograph should be obtained to look for evidence of active pulmonary infection. (Low, Strong)

Deceased donors with a history of an untreated LTBI but without evidence of active disease are acceptable but warrant consideration of treatment of the recipient(s) with isoniazid. (Low, Strong)

Routine donor screening of all donors for histoplasmosis from an endemic area is not warranted; however, explanted organs that may have granuloma should prompt fungal culture and testing for antigen and antibodies to Histoplasma. (Low, Strong)

Calcified pulmonary, hilar, and splenic granulomata that are suggestive of old Histoplasma infection are not a contraindication to donation. (Low, Weak)

Screening for Coccidioides should be considered in living donors from endemic areas; however, universal screening is not recommended for those outside the endemic area. (Moderate, Strong)

Screening of cryptococcosis should be considered in donors who have meningoencephalitis of unknown etiology, pulmonary nodules of unknown etiology, or fever of unknown origin if they have underlying medical conditions that predispose to this infection (eg, end stage liver/renal disease, rheumatologic disorder, sarcoidosis, or receipt of corticosteroid/immunosuppressant). (Moderate, Strong)

OPTN/UNOS mandates Toxoplasma screening by serology in all donors. (Moderate, Strong)

Donor seropositivity for Toxoplasma is not a contraindication to organ donation but allows for appropriate prophylaxis to be administered to the recipient. Routine trimethoprim‐sulfamethoxazole against Pneumocystis jirovecii prophylaxis or, if with sulfa allergy, atovaquone with or without pyrimethamine/leucovorin is effective in preventing toxoplasmosis transmission for mismatched heart and other organ recipients. (Moderate, Strong)

Screening for endemic infection including T. cruzi and Strongyloides should be performed based on epidemiologic risk factors. (Moderate, Strong)

Transplantation of the hearts from donors with positive T. cruzi serology should be avoided. (High, Strong)

All donors should be screened for CMV, EBV, HBV, HCV, and HIV. (High, Strong)

NAT is used in addition to serology for HCV screening of deceased donors. (Moderate, Strong)

HBV, HCV, and HIV screening of living donors should be close as possible to but no longer than 28 days prior to organ procurement. (Moderate, Strong)

Due to the low seroprevalence of HTLV‐1 in the United States and the poor positive predictive value of screening HTLV‐1/2 assays in this population, routine screening of all deceased donors is not recommended. (Moderate, Strong)

Living donors should have WNV NAT close to time of transplant. (Low, Strong)

Avoid donors with any form of unexplained or confirmed WNV encephalitis. (High, Strong)