Organ Transplants:

Four cases of WNV infection in organ transplant recipients have been traced to one infected organ donor, showing the potential risk to people receiving transplants.  However, screening organs for WNV poses particular problems, so universal screening has not been recommended.  There are nucleic acid tests  (NATs) available for use in screening organ and tissue donors, but a number of factors makes this screening impractical in most cases:

• The testing specimen must be obtained while the donor’s heart is still beating.
• NAT is done at a limited number of testing sites and many labs have not shown interest in testing samples from organ donors, so testing is not readily available.
• Many testing sites use a mini-pool format for the initial screening and individual testing is only done if the mini-pool tests positive for WNV, effectively delaying test results.
• The turn-around time from the time the donor blood sample is drawn until the results are reported back may be 24 hours or longer, depending upon availability of testing.  For non-urgent living donor transplants, this turn-around time isn’t a problem, but for deceased donors, the time may exceed the viability limit for an organ or tissue.

• Defer potential donors with encephalitis, meningitis, or flaccid paralysis of undetermined etiology who resided in geographic areas with known WNV activity.
• Exercise a high index of suspicion of WNV infection if an organ transplant recipient develops a febrile illness.  Perform an WNV IgM (antigen) test and a WNV—NAT if WNV infection is clinically suspected.
• Consider screening of living donors with WNV-NAT as close to the time of donation as possible, and then defer donation for 28 days if testing is positive. 

For deceased donors, HRSA recommends transplanting an infected organ only if the potential recipient has an emergent, life-threatening illness and no other organs or life-saving measures are available.

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