Interpreting Donor Microbiology & Serology

Lessons for Effective Infectious Risk Assessment & Post- Procurement Reporting

Guest Author:
Octavia Wyche
Organ Quality Coordinator
Nevada Donor Network

Why Donor Testing Matters

Every day, organ procurement organization (OPO) quality teams make high-stakes decisions about donor microbiology and serology results that can directly influence recipient outcomes and organ utilization. While reporting requirements are well established, interpreting results and communicating meaningful clinical context remains one of the most complex responsibilities in donation.

Effective post-procurement infectious disease reporting is more than a compliance activity. It is a collaborative process that supports informed decision-making by transplant centers, protects recipients, and helps ensure that every transplant opportunity is evaluated appropriately.

To better understand how complex infectious disease findings are assessed and communicated, Nevada Donor Network spearheaded a retrospective review of donor cases in our region involving post-procurement microbiology cultures and serology results. The goal was to identify practices that work, understand where clinical judgment is most critical, and share lessons that may be valuable across the donation community. 

Study Design

This retrospective case review examined more than 20 donor cases selected based on microbiological significance, clinical complexity, or reporting implications. The analysis included:

• • • Cultures spanning bacterial, fungal, and parasitic findings
    • Review of infectious risk stratification and internal quality workflows
    • Evaluation of reporting timelines, communication methods, and alignment with the Organ Procurement and Transplantation Network (OPTN) regulatory and accreditation standards

While the review represented a relatively small sample of cases, it provided valuable insight into the complexity of post-procurement infectious disease assessment and highlighted invaluable practices for OPO operations.

Results at a Glance

The review revealed several notable findings:

• • • 100% of donor cases reviewed across bacterial, fungal, and parasitic pathogens were communicated to transplant centers
    • 100% of results were communicated with clinical context; not simply forwarded as raw data
    • 100% of cases required the highest degree of interpretive judgment

These findings tell a story about the critical role OPO quality teams play in helping transplant centers make informed decisions for their patients.

However, reporting decisions were never straightforward. Although each case was unique, three variables drove every judgment call:

The organism mattered.

Species, burden, and clinical context shaped risk classification at every step. The same result carried different weight depending on what was growing, how much, and where.

The organ mattered.

A finding that might be low-risk for one organ type took on entirely different significance in another.

The geography mattered.

Certain pathogens, particularly parasitic and endemic fungi, demanded attention regardless of the organ procured.

Despite a well-structed internal workflow supported by accurate risk stratification and clear transplant center communication, no case was simple. The system held, but it held because people applied judgment, not because the checklist was sufficient.

Post-Procurement Cultures and Serologies: What the Data Showed

The microbiology and serology findings reviewed reflected the wide range of infectious disease considerations OPO quality teams encounter in routine practice.

Across the cases reviewed, 15 unique bacterial and fungal organisms were identified, including Staphylococcus aureus, Pseudomonas aeruginosa, various Candida species, Salmonella enterica, Stenotrophomonas maltophilia, and Klebsiella aerogenes. While some findings represented common organisms frequently encountered in clinical settings, others required heightened attention based on culture source, organ type, recipient risk, or potential for donor-derived transmission.

Serology testing included screening for regionally relevant and transplant-significant pathogens such as Coccidioides, Strongyloides, Histoplasma, and Trypanosoma cruzi (Chagas disease). Although only one donor tested positive for Coccidioides in this review, each result required evaluation within the donor’s geographic and clinical context.

Several findings also met criteria for pathogens of special interest (POSI), triggering additional reporting requirements beyond standard post-procurement communication. This dual reporting obligation reflects the recognized risk these organisms carry for recipients and supports the broader public health infrastructure designed to detect, investigate, and prevent donor-derived transmission.

Ultimately, the review demonstrated that infectious disease reporting is rarely a simple matter of relaying laboratory results. The same finding can carry different implications depending on the organism, organ recovered, recipient considerations, and geographic factors involved.

Readers interested in a deeper review of the data and specific microbiological findings can access the full poster presentation from the AOPO 2026 Annual Meeting.

What We Learned

When quality teams approach donor microbiology not as a checklist, but as a discipline of interpretation, they tell transplant centers what they need to know.

Standardizing communication and documentation practices does more than satisfy regulators: it builds trust between OPOs and transplant centers which creates a strong foundation for effective collaboration that supports every future organ offer.

Transferable Takeaways for OPO Quality Teams

While these findings emerged from Nevada Donor Network’s experience, the lessons are broadly applicable across the OPO community.

Document the Decision-Making Process: Standardize escalation pathways so no result exits without a trail. Every case should have a documented record of who reviewed it, what context was applied, and what clinical decision it informed.

Communicate Risk Consistently: Develop reporting language templates that communicate risk level clearly and are not invented from scratch each time. Organ type, organism significance, geographic considerations, and recommended recipient follow-up should all be addressed consistently.

Learn from Every Complex Case: Build knowledge-sharing loops after every complex case. After-action reviews, team huddles, and education touchpoints following difficult cases build institutional knowledge that no policy document can replicate.

Build a Culture Beyond Compliance: Treat OPTN alignment as a floor, not a ceiling. Regulatory compliance is the baseline. Quality teams that treat post-procurement reporting as a discipline go further. This builds the trust and transparency needed to increase donation and transplantation while maintaining the highest standards of recipient safety.

Conclusion

Post-procurement infectious disease reporting is one of the highest-stakes communication responsibilities within the donation process. It is time-sensitive, clinically complex, and carries implications for recipient safety and organ utilization.

This case review affirmed what many experienced quality professionals already know: interpretation is not optional. It is the job. And when we do it well, with standardized workflows, clear language, and geographic and clinical context, we give transplant centers exactly what they need to make the right decision for their patient.

To view the full report details click on the Case Data & Reference Handout and 2026 AOPO Abstract Poster.

Scan the QR code for full case findings and reporting timelines.

About the Author:

Octavia Wyche was selected as an Abstract Poster Presenter at the 2026 AOPO Annual Meeting in Orlando, Florida.

Octavia Wyche is an Organ Quality Coordinator at Nevada Donor Network, where she specializes in post-procurement infectious disease reporting, regulatory documentation, and quality assurance. With a background in biology, medical science, and medical writing, Octavia brings a research-driven lens to the intersection of data interpretation and transplant safety. She was recognized as Nevada Donor Network’s Q1 2025 Employee of the Quarter for exceptional documentation quality and regulatory performance.

Learn more about Octavia’s research and Nevada Donor Network.