In July 2013, the U.S. Public Health Service (PHS) published new guidelines for reducing human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) transmission through organ transplantation. These new guidelines, called "increased risk" guidelines, replaced earlier guidelines from 1994 called "high risk" criteria. The phrase "increased risk" refers to the donor characteristics that could place the potential recipient at increased risk of disease transmission. The phrase is not a reference to organ quality, nor should it be interpreted to be a predictor of graft survival.

A potential organ donor may be labeled as increased risk for a variety of different exposures, and these exposures carry different risks of transmitting recent infection with HIV, HBV, or HCV. Helping transplant patients understand the potential risks of disease transmission from increased risk organs versus refusing an organ for transplant is an important, but challenging topic. The transplant community has requested assistance explaining relative risk of disease transmission involving increased risk organ donors to potential organ recipients. The OPTN/UNOS Ad-hoc Disease Transmission Advisory Committee (DTAC), in collaboration with the Joint Society Steering Committee, developed this document to inform and facilitate conversations between transplant team members and their patients. The guidance profiles recent peer reviewed literature and OPTN data to describe the risk of undetected disease transmission from PHS increased risk organ donors.

This guidance document will help transplant clinicians in decision-making during organ offers from OPOs, and allow them to consider the risk of undetected HIV, HBV, or HCV infection in the donor. This guidance also provides speaking points to transplant program staff for patient education. This will guide the decision-making process whether the patient may want to consider an organ from an increased risk donor at the time of organ offer.