*Purpose: Rates of Gram-negative (GN) organ donor disease transmission are unknown. Potential donor-derived transmission events (PDDTE) reported to the OPTN Ad hoc Disease Transmission Advisory Committee (DTAC) are reviewed and classified according to the likelihood of disease transmission. To better understand GN-PDDTE infections, we analyzed all PDDTE of Enterobacteriaceae and clinically significant non-fermenters.

*Methods: Retrospective study of GN-PDDTE, 2012-2018. Events were reported as result of disease in the recipient or positive donor microbiologic data. Adjudication of the cases was based on a DTAC standardized classification algorithm.

*Results: Cases reported from 2012-2018 involved 71 donors and 211 recipients. Case adjudications included 31 proven/probable (P/P), 5 possible, and 35 intervention without disease transmission. Antibiotic history was unavailable in 48% P/P donors. Of 29 P/P donors with positive cultures, susceptibility testing was unavailable for 6 (21%). Recipient-level data were reviewed for 89 recipients of 31 donors with P/P transmission. GN-PDDTEs occurred in 47% of recipients from P/P donors; recipients of lungs then kidneys were highest risk (Figure 1). Attributable mortality was 14%. Multidrug-resistant GN transmissions occurred in 8 recipients from 5 donors (4 with carbapenem-resistant K. pneumoniae [CRKP] and 1 with carbapenem-resistant A. baumannii [CRAB]).

*Conclusions: 31 (44%) of reported cases resulted in P/P GN transmissions, 16% due to MDRGNR. Lung recipients appear to be at increased risk for PDDTE-GN transmission events. Donor antibiotic history and susceptibility testing may inform earlier treatment of recipients.

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