Donor-derived viral infections: the usual suspects and the new kids on the block

The expansion of the transplant donor pool, driven by the need to reduce the disparity between supply and demand, carries the risk of use of marginal donors with viral infections, including classic viruses and emerging threats. This narrative review analyzes these challenges, including new opportunities in managing well known viruses such as Hepatitis B, Hepatitis C and Human Immunodeficiency Virus in both donors and recipients, thanks to new effective antivirals. Furthermore, we highlight the importance of monitoring emerging viral pathogens, such as Hepatitis E and Human Herpesvirus 8 (HHV-8) implementing both targeted pre-transplant donor screening and timely post-transplant diagnosis in the recipient, enabling earlier therapeutic intervention and potentially reducing recipient morbidity and mortality. Moreover, respiratory viral infections have gained significant attention as potential causes of donor derived infection (DDI) transmitted to the recipient, particularly within specific widespread and seasonal contexts, and require further attention and investigation. Continuous updates to surveillance and screening protocols are essential to optimize outcomes of recipients, ensuring transplant safety.