Ten years of donor-derived disease: A report of the disease transmission advisory committee

Abstract

Despite clinical and laboratory screening of potential donors for transmissible disease, unexpected transmission of disease from donor to recipient remains an inherent risk of organ transplantation. The Disease Transmission Advisory Committee (DTAC) was created to review and classify reports of potential disease transmission and use this information to inform national policy and improve patient safety. From January 1, 2008 to December 31, 2017, the DTAC received 2185 reports; 335 (15%) were classified as a proven/probable donor transmission event. Infections were transmitted most commonly (67%), followed by malignancies (29%), and other disease processes (6%). Forty‐six percent of recipients receiving organs from a donor that transmitted disease to at least 1 recipient developed a donor‐derived disease (DDD). Sixty‐seven percent of recipients developed symptoms of DDD within 30 days of transplantation, and all bacterial infections were recognized within 45 days. Graft loss or death occurred in about one third of recipients with DDD, with higher rates associated with malignancy transmission and parasitic and fungal diseases. Unexpected DDD was rare, occurring in 0.18% of all transplant recipients. These findings will help focus future efforts to recognize and prevent DDD.

Donor to recipient transmission of SARS-CoV-2 by lung transplantation despite negative donor upper respiratory tract testing

“…Unexpected transmission of infection from donor to recipient is uncommon, occurring in fewer than 1% of transplant recipients 1 . Nonetheless, donor‐derived disease (DDD) is associated with poor outcomes including graft loss or death noted in about one‐third of affected recipients 1 .…”

Testing deceased organ donors for infections: An organ procurement organization survey

“…Nonetheless, transmissions with these pathogens continue to occur and may have been prevented with wider screening. 10 Testing organ donors for infectious diseases is important to protect the organ recipients by allowing for treatment of infection, monitoring for infection or rarely, to decline use of organs for a specific recipient. Having as much information as possible regarding serious and transmissible infectious diseases present in a donor also allows for informed consent with recipients regarding what to expect after transplantation.…”

“…9,[12][13][14][15][16][17][18][19][20][21] The OPTN ad hoc Disease Transmission Advisory Committee reported proven/probable cases of unanticipated donorderived disease from 2008 through 2017; there were 10 cases of coccidioidomycosis, 13 cases of Strongyloidiasis, 11 cases of Toxoplasmosis, three cases of Chagas disease, and five transmissions of WNV. 10 The mortality rate for recipients who acquired a donorderived infection was 15%, with highest rates in those infected with Strongyloides, Toxoplasmosis, and Coccidioides. 17 The American Society of Transplantation Infectious Diseases Community of Practice guidelines summarize the current recommendations for screening of donors for seasonal and geographically restricted endemic infections.…”

Cryptococcus transmission through solid organ transplantation in the United States: A report from the Ad Hoc Disease Transmission Advisory Committee

“…As previously mentioned, IWDT designation has evolved over time and therefore, some of the classifications presented here may have been differently adjudicated when applying subsequent criteria. 17 Finally, data available on each case reviewed by DTAC are limited to 45 days after the initial report and by the information released by the donor and transplant centers which may not include all medical records or treatment specifics such as type, dosing, and duration. Accordingly, these limitations may have reduced DTAC's ability to correctly adjudicate donor-derived cryptococcosis or identify all donor risks or recipient use of prophylaxis.…”