The equation of risk for infection in organ transplantation revolves around a semiquantitative relationship between the recipient’s epidemiologic exposures and the “net state of immunosuppression”. Infections derived from the donor pose a unique challenge in the effectiveness of transmission with the implanted organ bypassing host defenses with signs and symptoms often masked by recent surgery. Manifestations of infection are often further masked by induction immunosuppression. Donor screening is limited in time available before transplantation, by available microbiological assays, and by local policies. Further, recent infectious exposures may fail to provoke a serologic response or, in the case of viruses, adequate replication for detection by nucleic acid testing (the “window period”). Absolute prevention of donor-derived infection is not feasible. However, deployment of newer technologies such as advanced sequencing technologies may contribute to transplant safety.
