Rationale:

• Immunosuppressed persons may receive viremic organs from asymptomatic donors through transplantation.

Evidence:

• WNV has been transmitted via organ transplantation from a viremic, IgM-negative donor as well as from a nonviremic, IgM-positive donor (8; 9).

Comments:

• Recommendations by the Organ Procurement and Transplantation Network suggest that donors with encephalitis, meningitis, or flaccid paralysis in geographic areas with human WNV infection be deferred. Universal screening is not recommended, but organs from donors with known reactive WNV nucleic acid detection tests before transplantation should be used only if the recipients are informed of the risk and have an emergent life-threatening illness requiring transplantation and no suitable alternative therapy.
• No FDA-licensed WNV nucleic acid detection test for organ donor screening exists.
• A cost-benefit analysis indicated that universal nucleic acid detection screening could result in a net loss of life for heart and liver recipients (21).
• Transmission from organs from a nonviremic, IgM-positive donor indicate that nucleic acid screening may be less effective for organ donors than for blood donors.