Risk and benefits of expanded donor screening: A viewpoint from Germany.

Area of Science:

• Transplantation immunology
• Infectious disease screening
• Public health policy

Background:

• Organ transplantation relies on donor screening to prevent transmissible pathogen transmission.
• Current screening methods for deceased organ donors primarily use serological tests for common blood-borne viruses (BBVs).
• Evolving epidemiological factors and testing technologies necessitate a review of current screening protocols.

Purpose of the Study:

• To evaluate the risks and benefits of expanding transmissible pathogen screening in deceased organ donors.
• To analyze Germany's experience in donor screening procedures and decision-making.
• To address key issues impacting screening policies and mitigate unexpected transmission risks.

Main Methods:

• Review of existing literature and German screening practices.
• Analysis of the impact of universal versus targeted nucleic acid testing (NAT) for BBVs (HIV, HBV, HCV).
• Consideration of additional screening tests for geographically restricted regions and adaptation strategies for changing environmental and demographic factors.

Main Results:

• The effectiveness of donor screening depends on accurate donor characterization and timely initiation of appropriate tests.
• Decisions on implementing new screening tests must consider potential transmission risks and the limitations of current clinical judgment and specific tests.
• The review highlights the need for universal or risk-based targeted screening strategies for pathogens.

Conclusions:

• Expanding screening for transmissible pathogens in deceased organ donors requires careful consideration of risks, benefits, and implementation strategies.
• Nucleic acid testing offers potential improvements over serological tests for detecting BBVs.
• Adaptable screening strategies are crucial to address evolving public health challenges and ensure transplant safety.