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Improve Deceased Donor Evaluation for Endemic Diseases

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Current policy

Organ Procurement Organizations must test all deceased donors for certain infectious diseases. This is important for patient safety, as it helps protect transplant recipients from disease transmissions. Strongyloides and Trypanosoma cruzi (T. cruzi) are two of the most common parasitic infections reviewed by the Ad Hoc Disease Transmission Advisory Committee (DTAC). The DTAC proposes requiring antibody screening for Strongyloides for all deceased donors and T. cruzi antibody screening of deceased donors born in areas where Chagas disease regularly occurs.

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Proposed changes

  • Screen all deceased donors for Strongyloides
  • Screen deceased donors born in countries where Chagas disease regularly occurs for T. cruzi
  • If a screening test is positive for T. cruzi, additional testing would be done within 72 hours to confirm the results

Anticipated impact

  • What it’s expected to do
    • Improve transplant recipient safety through infectious disease testing to reduce disease transmission
    • Increase awareness and communications for potential endemic diseases across regions
  • What it won't do
    • Will not completely prevent T. cruzi or Strongyloides disease transmissions

Terms to know

  • Endemic Diseases: A disease that regularly occurs in a particular population or region.
  • Deceased Donor: An individual from whom at least one organ is recovered for the purpose of transplantation after declaration of death.
  • Organ Procurement Organization (OPO): An organization designated by the Centers for Medicare and Medicaid Services (CMS) that is responsible for the procurement of organs for transplantation and the promotion of organ donation. OPOs serve as the vital link between the donor and recipient and are responsible for the identification of donors, and the retrieval, preservation, and transportation of organs for transplantation.
  • Trypanosoma cruzi: The parasite that causes Chagas disease.
  • Strongyloides: A human pathogenic parasitic roundworm causing the disease strongyloidiasis, also known as threadworm.

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Read the full proposal

Provide feedback

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Anonymous | 02/01/2023

I support improved evaluation for endemic screening of deceased donors. As we know, there is a shortage of donors from other ethnicities that may have lived in these endemic areas. We understand that there is a higher chance of survival with donation within the same ethnicity. This will allow them to feel like they can still donate their organs, and will encourage them to sign up to be a donor. I think that recipients should be aware of this risk, as they do if their donor organ is high risk. It should be said that there may be side effects from the medication that would be used to treat these diseases. But overall, I think that the improved evaluation for endemic diseases is necessary for equality of organ donation among different ethnicities.

Ashrit Multani | 01/27/2023

I strongly support universal Strongyloides screening. Many of our donors have resided in or traveled to endemic areas. Some of our donors may not have complete travel histories obtained. There is a significant risk for donor-derived infection. I strongly support epidemiologic risk factor-based screening for T cruzi for donors from all endemic countries including the southern US given known autochthonous infections. However, the geographic criteria for this would need to be carefully considered. We have had a number of transplant candidates and recipients have T cruzi who do not have "classic" risk factors (e.g., residence in rural areas, thatch roofs, adobe walls, etc.) but instead hail from urban areas. I would support screening donors from all endemic countries. The other factor here is the known false-positive rate for serologies and the time-sensitive nature of organ procurement. It would be ideal if two different Chagas serologies could be sent simultaneously.