A-Z Index × Submit A-Z Index × Submit A-Z Index Search Dropdown × Submit Facebook Twitter LinkedIn Syndicate Emerging Infectious Disease journal ISSN: 1080-6059 Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.
Strongyloides stercoralis is a parasitic nematode endemic in tropical and subtropical regions, including parts of the southeastern United States, that can be transmitted via organ donation. As of October 2025, the Organ Procurement and Transplant Network implemented new policy for screening in deceased US organ donors to reduce the risk for donor-derived Strongyloides infection. To assess the potential effect of policy changes, we reviewed investigations of suspected transplant-related strongyloidiasis in the United States conducted by the Centers for Disease Control and Prevention and partners for solid organ transplants occurring during 2012–2024. During that period, 21 proven donor-derived strongyloidiasis cases originated from 15 unscreened donors. Of donors who were screened, 31 seropositive donors resulted in ivermectin prophylaxis for 77 recipients, none of whom had disease develop. Our findings support the effectiveness of universal organ donor screening and prophylactic ivermectin treatment of recipients to prevent donor-derived Strongyloides infection.
Solid organ transplantations are lifesaving; however, they can pose major risks for illness and death from transplant-related complications, including infection with the parasite Strongyloides stercoralis . S . stercoralis is a parasitic nematode endemic in tropical and subtropical regions, including parts of the southeastern United States, and is estimated to affect 300–600 million persons worldwide ( 1 – 3 ). Risk factors for acquiring Strongyloides infection include living in or traveling to endemic regions, activities involving direct skin contact with soil, living in long-term care or correctional facilities, and human T-lymphotropic virus 1 (HTLV-1) infection ( 1 , 4 , 5 ).
S . stercoralis nematodes have a unique autoinfection cycle that enables them to establish asymptomatic, chronic infections even in immunocompetent persons ( 1 , 4 – 6 ). Immunocompromised persons, including solid organ recipients, have increased risk for severe disease because of infection reactivation or donor-derived infection ( 6 , 7 ). Severe disease is characterized by hyperinfection syndrome or disseminated Strongyloides infection, or both, and can have high mortality rates that reach up to 90% ( 8 , 9 ). Ivermectin is the treatment of choice for strongyloidiasis and has high efficacy, achieving cure rates of up to 96% in clinical trials ( 6 , 10 – 13 ).
To reduce the risks associated with donor-derived infections, the Organ Procurement and Transplant Network (OPTN) in the United States added S. stercoralis screening to policy 2.9, Required Deceased Donor Infectious Disease Testing, as part of the initiative to improve deceased donor evaluation for endemic diseases ( 14 ). This policy requires organ procurement organizations (OPO) to obtain serologic testing for S. stercoralis infection as part of the deceased donor evaluation process. The policy was approved in June 2023 and implemented in October 2025; testing all donors in the interim was highly recommended ( 15 ). When new donor testing information indicating a positive test becomes available, the OPO must not…