Selecting suitable solid organ transplant donors: Reducing the risk of donor-transmitted infections

Table 2 Approach to selecting suitable donors for solid organ transplantation

Infections	Diagnostic tools	Treatment considerations
Bacteremia	Blood cultures	Treat donor 24 h
	Antibiogram	Tailored recipient therapy in posttransplant period
Resistant bacteria	Blood cultures	Tailored donor and recipient therapy
	Sterile site cultures
	Antibiogram
Meningoencephalitis	CSF analysis	Tailored therapy if meningitis only
	CSF culture and stain
	Cryptococcus antigen
	NAAT
Syphilis	Treponemal testing	Treat recipients as late latent syphilis
	Nontreponemal testing
Viral hepatitis	Serologic evaluation NAAT	Prophylaxis Tailored therapy HBIG Antivirals
Influenza	Influenza testing	Neuraminidase inhibitor
	Respiratory virus PCR
HTLV 1/2	Routine screening not recommended	No effective treatment, surveillance for recipients of positive donors
Candida infection	Blood cultures Sterile site cultures Antibiogram	Antifungal treatment of donor
		Treat colonization in certain settings
Cryptococcosis	CSF cryptococcal antigen	Antifungal treatment of donors prior to donation
	Serum cryptococcal antigen
Endemic fungi	Urine antigen testing	Antifungal treatment of donors prior to donation
	Serologic evaluation
	Sterile site culture
	Histologic evaluation
Schistosomiasis	Stool examination	Treat living donor successfully prior to donation
	Serologic evaluation
	Rectal biopsy
Strongyloidiasis	Serologic evaluation	Treat recipients from positive donors
	Stool examination
Chagas disease	Enzyme immunoassay	Treat recipient for positive surveillance testing
	Radioimmune precipitation assay

HTLV: Human T-lymphotropic virus; NAAT: Nucleic acid amplification testing; PCR: Polymerase chain reaction; HBIG: Hepatitis B immunoglobulin.