Evaluating Infections in Solid Organ Donors Before Transplantation: A Systematic Review of Clinical Practice Guidelines

Background Donor-derived infection remains a risk in solid organ transplantation. Clinical practice guidelines inform best practices for donor evaluation and acceptance, although they vary across centers and regions. This study aimed to evaluate the quality and consistency of guidelines for the evaluation of infections in solid organ donors and to summarize their recommendations. Methods We searched electronic databases and websites of professional organizations for clinical practice guidelines and consensus statements on evaluating solid organ donors for the presence and risk of infection. The methodological quality was assessed using the Appraisal of Guidelines for Research and Education II tool. Textual synthesis was used to compare the recommendations and summarize their conclusions. Results We included 19 clinical practice guidelines and 19 consensus statements covering different donor types (deceased/living, adult/pediatric), solid organs (liver, kidney, lung, heart, and pancreas) and infection types (viral, bacterial, fungal, parasitic, and prion). Most guidelines focused on describing the scope and purpose, but with less emphasis on domains such as the guidelines' applicability and rigor of development. Recommendations for screening and organ acceptance were generally consistent for hepatitis B virus, hepatitis C viru, HIV, Mycobacterium tuberculosis , Toxoplasma gondii , and Treponema pallidum infections. Variations exist, especially for emerging infections or when the screening test performance was poor. Most recommendations were ungraded. Conclusions Recommendations for common infections were mostly consistent. Where uncertainties exist, transparency in evidence synthesis and translation into recommendations is needed. Real-world evaluation of guideline implementation and its clinical impact is crucial for maximizing donor organ use while minimizing donor-derived infections.