Selecting suitable solid organ transplant donors: Reducing the risk of donor-transmitted infections

Table 3 Suggested approach to donor-transmitted Mycobacterium tuberculosis

Deceased donors
1TB Risk	2Suggestive radiology	3Donor testing	4Donor treated	Accept allograft	Additional consent	5Recipient treatment	Additional recipient testing
Low	No	Negative	N/A	Yes	None	None	None
Low	Yes	Negative	No/Yes	Yes	Yes	Chemoprophylaxis	None
Low	Yes	Pending	No/Yes	No	N/A	N/A	N/A
Elevated	No	Negative	No/Yes	Yes	Yes	Chemoprophylaxis	None
Elevated	Yes	Negative	No/Yes	Yes	Yes	Chemoprophylaxis	None
Elevated	Yes	Pending	No/Yes	No	N/A	N/A	N/A
Elevated	Yes	Positive	No/Yes	No	N/A	N/A	N/A
Prior active TB	Yes	Negative	Yes	Yes	Yes	Chemoprophylaxis	None
Prior active TB	Yes	Pending	Yes	Yes	Yes	Chemoprophylaxis	None
Prior active TB	Yes	Positive	No/Yes	No	N/A	N/A	N/A
Prior active TB	Yes	Positive	No	No	N/A	N/A	N/A
Active TB	Yes	Positive	No/Yes	No	N/A	N/A	N/A
Living donors
Low	No	Negative	N/A	Yes	No	None	None
LTBI	No	Positive	Yes	No	Yes	None	None
Active TB	No	Positive	No	No	N/A	N/A	N/A
Elevated	Yes	Negative	No/Yes	Yes	Yes	Chemoprophylaxis	None

¹Based on history and physical examination;

²Apical fibrosis and/or pleural thickening on chest radiograph or computerized tomography scan;

³Sputum acid fast bacilli (AFB) smear and culture; molecular testing on smear-positive sputum;

⁴Must be documented treatment with appropriate anti-TB therapy;

⁵Refers to accepted regimen for treatment of latent tuberculosis infection (LTBI). TB: Tuberculosis; N/A: Not applicable.