Ethical Priorities for Candida auris Screening in Solid Organ Transplantation

Candida auris is an emerging, multidrug-resistant fungal pathogen of growing concern in solid organ transplantation, where colonization may have implications for pretransplant candidacy and post-transplant outcomes. Although C. auris screening is increasingly common in presurgical and critical care settings, no national or professional guidelines in the United States specify who, how, or when to screen, nor is there consensus on how screening results should impact patient care. Here, we examine the ethical significance of C. auris colonization in transplant candidacy decisions and outline the arguments for and against universal C. auris screening of solid organ recipients in the peritransplant period. We propose risk-based screening as a middle-ground approach for hospitals and physicians seeking to develop value-informed, evidence-based guidelines at a time when data are still emerging and evolving. Ultimately, the fundamental goal of pretransplant screening is harm reduction through preparedness and individualized risk assessment, not a proxy for institutional risk tolerance or an artifact of how a screening policy is applied.