*Purpose: Donor-derived infections are associated with significant morbidity in solid organ transplant recipients. To reduce the risk of donor-derived infections, the United Network for Organ Sharing (UNOS) requires all deceased organ donors undergo testing for infectious diseases (ID). In this study, we evaluated the level of, and regional variations in, missing donor ID testing across the US.

*Methods: A retrospective cohort study was performed including all deceased donors in the US between 1/1/2016 and 6/30/2021. Donor ID testing was considered incomplete if one or more of the required ID tests was reported as “unknown” or “not done” to UNOS (including HIV Antigen [Ag]/Antibody [Ab], HIV nucleic acid test [NAT], Hepatitis C [HCV] Ab, HCV NAT, Hepatitis B [HBV] surface Ag, HBV core Ab, HBV NAT after 2020, Cytomegalovirus Ab, Epstein-Barr Virus Ab, Toxoplasma Ab after 2017, and syphilis testing). Data were collected from the UNOS Standard Transplant Analysis and Research file. The association between organ procurement organization (OPO) Region and incomplete donor ID testing was evaluated using a multivariable logistic regression model adjusted for calendar time.

*Results: A total of 58,092 unique organ donors were included, of which 251 (0.4%) had at least one incomplete ID test reported. The most commonly missing ID tests were Toxoplasma Ab (0.22%) and HBV core Ab (0.10%). Testing for HIV and HCV was incomplete in only 0.01% of donors. HBV surface Ab testing, which is not required, was incomplete in 49,611 (85%) donors. After adjusting for calendar time, incomplete donor testing was more common in OPO Region 3 (aOR 2.1, 95% CI 1.0-4.4, P=0.04), Region 4 (aOR 3.7, 95% CI 1.8-7.5, P<0.01), Region 5 (aOR 3.1, 95% CI 1.5-6.3, P<0.01), and Region 9 (aOR 4.3, 95% CI 2.0-9.4, P<0.01) (compared to Region 7 which had the fewest donors with incomplete ID testing).

*Conclusions: ID testing is completed per UNOS requirements in over 99.5% of deceased donors, though there are rare instances of missed tests, particularly for Toxoplasma and HBV. Tests that are recommended, but not required, such as HBV surface Ab, are rarely performed/reported. Though the absolute rates of missing tests were small, there was measurable regional variation in testing completeness. Further studies are needed to explore whether missing ID tests are due to errors in testing versus reporting of results.

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