Infection and Cancer Screening in Potential Living Donors: Best Practices to Protect the Donor and Recipient

Abstract

Twenty-one percent of transplants in the US come from live donors. Data show that live-donor transplantation is a safe practice, but is not completely risk free. Malignancy and infection transmission through live organ donation is extremely rare, but can be a devastating event for the recipient, donor and treatment team if it occurs. The donor evaluation is multifactorial, taking into the account the unique medical, social and family history of individual donors, needs of the recipient, and determination of the anatomic and functional suitability of the donor organ, and is further complicated by geographical and temporal components. While balancing all practical considerations can be complex, a thorough medical assessment for infection and malignancy of potential living donor is central in protecting the donor and the intended transplant recipient.

Evaluation of donor workups and exclusions in a single‐center experience of living donor liver transplantation

“…General health of potential donors is not only related to donor safety but also the risk of disease transmission. Besides cancer and infectious disease, rare metabolic and inherited diseases can also be transmitted from donor to recipient …”

“…For potential donors in the minimal and low‐risk category, the decision for donation should be made based on individualized clinical judgment and comprehensive informed consent. Specifically for the low‐risk category, organ donation is only advisable if the recipient is at a significant risk of mortality …”

Summary of Kidney Disease

“…Microbiological screening should be performed if regional epidemiology or individual clinical or social history suggests increased risks for Mycobacterium tuberculosis , Strongyloides, Trypanosoma cruzi , West Nile virus, histoplasmosis, or coccidiomycosis. 43 In addition, transplant programs should develop and maintain protocols to screen donor candidates for emerging infections in consultation with local public health specialists. Donor infection risk factor and microbiological assessments should be performed or updated as close to donation as possible.…”

Receiving the Unwanted Gift: Infection Transmission through Organ Transplantation

“…The national experience differs slightly year by year, but the patterns associated with unexpected infection transmissions have remained fairly constant: (1) Infections caused by pathogens that are not tested for (such as rabies, West Nile virus [WNV], lymphocytic choriomeningitis virus (LCMV), strongyloides, and a variety of fungi); (2) infections from a donor with a pathogen found/recognized at the time of donation, with or without treatment prior to donation (most commonly bacteria) [11]; and (3) testing error or misinterpretation of the meaning of a result. fungi, and then other viruses [7,14].…”

“…There are no data on event frequency when organ donors have suffered neurologic death without a clear pathophysiologic understanding and those organs were used without subsequent disease transmission. However, there are numerous reports of rabies, LCMV, Balamuthia, coccidioidomycosis, and leukemia transmissions to recipients of organs from donors with either undiagnosed or misdiagnosed inflammatory conditions of the meninges or brain [11,24].…”