*Purpose: Mycobacterium tuberculosis can be transmitted via organ donation. Failure to recognize tuberculosis (TB) may result in significant morbidity and mortality. Currently, donor screening for TB is not universal. Potential donor-derived transmission events (PPDTE) reported to UNOS Ad hoc Disease Transmission Advisory Committee (DTAC) are reviewed and classified according to the likelihood of disease transmission. To better understand donor-derived tuberculosis (DDTB) to identify opportunities and to improve case identification, we analyzed all PDDTE of TB reported to DTAC over 10 years.

*Methods: This is a retrospective study of potential DDTB transmission events reported to DTAC: 2008-2017. Events were reported as result of disease in either recipient or positive donor microbiologic data for TB. Adjudication of the cases was based on the DTAC standardized classification algorithm.

*Results: Proven/probable (P/P) DDTB developed in 11 organ recipients from 9 deceased donors during this period. TB was detected after procurement as a result of OPO donor testing in 1 report resulting in 2 probable transmissions. Nine of 11 (82%) were reported due to recipient disease. Transmissions were reported in 6 lung and 5 non-lung recipients (2 kidney,2 liver, 1 liver/kidney) Two of the 11 recipients were born or traveled to TB endemic areas. The median time to diagnosis was 104 days (IQR 80-132). Seven recipients (64%) were symptomatic; pulmonary and extrapulmonary manifestations were present in 3 and 5 recipients, respectively. Four (36%) recipients were asymptomatic; 2/4 had evidence of latent TB infection (LTBI) when screened post-notification. All 11 P/P DDTB cases received treatment. There was no evidence of multidrug-resistant TB in any of the P/P DDTB cases. One died, but the death was not attributed to TB. All donors had at least one risk factor: 7/9 born/traveled to endemic area, 3/9 with prior incarceration, 3/9 with LTBI, and 2/9 with abnormal chest radiograph finding. All donors lacked clinical symptom suggestive of active TB prior to their demise.

*Conclusions: This case series highlights that donors should be screened for TB based on risk factors including exposure to endemic areas, prior incarceration, prior LTBI, and abnormal chest radiographic findings. Disease in the early post-transplant period among recipients with at-risk donors should prompt evaluation for possible DDTB.

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