Resources
- Letter from OPTN President John Magee
- Policy Notice (PDF - 367 KB)
Background
The purpose of these policy changes is to improve patient safety by reducing the risk of donor-derived transmission of Human Immunodeficiency Virus (HIV) and West Nile Virus (WNV) through solid organ transplantation.
Recent donor-derived transmission events demonstrated that the existing testing windows for HIV and WNV may not detect infections acquired shortly before organ recovery. Although testing was completed in accordance with OPTN policy, infections occurring after donor testing but before organ recovery resulted in transmission to transplant recipients.
To reduce this risk, the OPTN Board of Directors approved emergency policy changes requiring HIV and WNV testing for living donors to be performed as close as possible to organ recovery, but within 7 days prior to organ recovery for living donors.
Living donor recovery hospitals and transplant hospitals will need to update donor evaluation workflows and laboratory scheduling practices to ensure HIV and WNV are performed within the revised 7-day testing window.
Based on the implementation date of August 17, 2026 for WNV and HIV testing, WNV and HIV testing results must be available from within 7 days for all living donor surgeries that occur on or after August 24, 2026.
These changes strengthen donor infectious disease screening and better align testing with the period of greatest clinical relevance immediately preceding organ recovery.
Sponsoring Committee: Ad Hoc Disease Transmission Advisory Committee
Board Approved: June 18, 2026
Effective Date: Aug. 17, 2026
Summary of changes
- Reduce the required living donor HIV NAT testing window from 28 days to 7 days prior to organ recovery.
- Reduce the required living donor WNV NAT testing window from 14 days to 7 days prior to organ recovery.
- Continue to require testing to be performed as close as possible to organ recovery.
Frequently asked questions
Yes, the WNV testing requirements apply to all living donors. However, in some cases, such as domino liver transplant cases, we recognize that these testing requirements may not be feasible. In these rare circumstances, an individualized approach should be taken, and if testing is not performed within 7 days of organ recovery, the transplant center should document a risk/benefit discussion with the intended recipient and/or their proxy and submit a notice of variance to the patient safety portal.
Any FDA-cleared, approved, or licensed test is acceptable. For WNV, a nucleic acid test (NAT), e.g. PCR, should be used. For HIV, a 4th generation test (antigen/antibody combined) and NAT should be used.
Transplant centers should test all living donors for WNV beginning August 17th, 2026. This will ensure testing results will be available within 7 days for all living donor surgeries that occur on or after August 24, 2026. All donor procedures performed on or after August 24, 2026 need to have had testing performed with 7 days.
Yes. The living donor procedure should not begin unless the test result is known.
All WNV tests must be FDA-cleared, approved, or licensed to meet this testing requirement.
For living liver donors, we occasionally encounter situations in which a recipient's clinical condition deteriorates rapidly, and our physicians determine that an urgent living donor transplant is the most appropriate course of action. Although these circumstances are uncommon, they may necessitate proceeding with transplantation before WNV NAT results are available. This policy is not intended to prevent access to life-saving transplantation. In these rare cases, if testing is not performed within 7 days of organ recovery, the transplant center should document a risk/benefit discussion with the intended recipient and/or their proxy and submit a notice of variance to the patient safety portal.
The 7 day interval will be measured by the date of the blood draw and the date of donation. So for a donor procedure scheduled for the 24th of the month, the donor blood draw should be on the 17th. The hour of the day does not need to be tracked.
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