Donor evaluation follows similar criteria and pathways as in the selection of donors for multiple-solid-organ donation. The transplant team addressed any general and formal legal issues and protocols in place for any given country. It is very important to remind that when the evaluation is performed in any immigrant donor, a very careful evaluation is mandatory, since there is the possibility to import certain exotic infectious diseases in recipients. Under this circumstance, any exotic viral and bacterial infections should be ruled out, and any vector for encephalitis discarded. When a donor becomes available and is considered for multiple organ donation, a full panel in blood test is run, including tissue typing, ABO and rhesus typing, serology for common infections and hepatitis, CMV and Epstein–Barr. Special attention must be paid in VCA donors to multiple resistant microorganisms; thus microbial culture of the nasal fossa and nasopharynx is mandatory. Current PCR tests provide results few hours after full evaluation.

The transplant infectious disease specialist is a key team member of the transplant team. His/her full evaluation and recommendation before, during and after the transplant is extremely relevant to avoid significant complications and medication side effects during the whole lifespan of the transplant recipient.

Infectious disease specialists interview and evaluate patients during the whole initial evaluation of candidates and deliver their advice/prevention/treatments. During this evaluation, special attention is focused on current or past immunosuppression treatments, known allergies to antimicrobials and a thorough anamnesis of infectious diseases (Table 9.1). Apart from the past medical history regarding exposure to infectious disease vectors and diseases, the team focuses on other social issues such as travel to endemic locations for certain diseases (endemic parasitic and mycosis diseases), exposure to tuberculosis and past results of skin tests or chest X-ray alterations, risk factors for transmission of diseases in blood transfusions and current and future contact to children. Domestic issues are also explored. They include pets, nutritional habits (raw meat, seafood, no pasteurised milk and milk products, etc.) and type and origin of tap water.

A complete physical examination focuses on similar issues. It should uncover any current or past medical history/exposure to any microbial vector that may have implications in the transplant population. The physical examination is completed with a dental exploration and urological/gynaecological examinations.

Special explorations during this phase from an infectious disease perspective include tuberculosis assay, chest X-ray and face sinus X-ray exploration. Face CT scan performed during the general face transplantation candidate evaluation should focus on active sinus disease and teeth exploration in order to rule out any active problems. They should be treated before the patient enters active search for donors. Multiple resistant bacteria deserve special attention. Patients that have had multiple hospital admissions and operations and stay in intensive care units are possible vectors for these bacteria. Nasal, pharyngeal and tracheotomy cultures are mandatory to explore the possibility for reservoirs.

Blood tests are drawn to check common serology of relevance for posttransplant immunosuppression; they include the following:

More than ever, in a global world, patients that are referred or have migrated from countries with known exotic infectious diseases must be explored for endemic infections that may develop during or after the transplant. They may include the following:

Any positive finding should be individually investigated and treated if indicated. Patients that are reservoirs for multiple resistant bacteria are treated accordingly to eradicate the colonisation.

Preventive medicine professionals are important partners of the transplant infectious disease team. As in any other medical discipline, the ideal scenario is to prevent any infections or disease in order to avoid complications and the necessity to start medications, treatments and hospital admissions. Infections and metabolic alterations may lead to rejection episodes, end organ failure and hospital readmissions and transplant failure. Table 9.2

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