*Purpose: The OPTN DTAC, a multidisciplinary group, evaluates potential donor derived transmission events (PDDTE), mostly infections (I) & malignancies (M), to assess the likelihood of disease transmission.

*Methods: This is a retrospective study of PDDTE cases reported to the OPTN between 01/18 and 12/18. DTAC reviewed cases using a standardized classification algorithm.

*Results: During 2018, there were 17,570 donors and 36,529 recipients. DTAC reviewed 256/276 cases reported. 55 /256 (21.5%) donors had proven/probable (P/P) transmission of I, M or other conditions to 77 /172 (44.8%) exposed recipients [figure]. 9 involved living donors. Infections made up 36/55 P/P cases affecting 50 recipients. Viruses caused the most frequent P/P infections; 16 recipients from 12 donors had P/P transmission. HBV & HCV accounted for 28 of the 48 virus reports; 7 recipients had P/P transmissions from 6 donors. Parasites (49 reports) resulted in 8 donors transmitting to 8 recipients with 2 attributable deaths. 12 donors with malignancies were classified as P/P; 17 impacted recipients and ultimately 7 attributable deaths. 24 non-I, non-M PDDTE were also reported; 7 resulted in P/P transmissions to 10 recipients. Deaths from infection (N=6) occurred a median of 50 days (30-113 days), whereas deaths from malignancy (N=7) occurred a median of 95 days (47-176 days).

*Conclusions: Although P/P events remain rare, 1/5 reported cases resulted in unanticipated P/P transmission. This is a conservative estimate; some recipients received an intervention to ameliorate risk and the reporting system is passive. Infections were the most commonly reported event. Lung recipients appear disproportionately represented in this cohort and may have increased risk for donor derived transmission events. Donor-derived malignancy, while uncommon, carries a significant mortality. The DTAC continues to evaluate PDDTE to maximize organ use and assess preventative strategies to minimize risk of transmission.

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