What considerations are needed for a potential kidney donor who developed viral gastroenteritis (inflammation of the stomach and intestines caused by a virus) or foodborne illness while traveling abroad, prior to a scheduled donation in 40 days?

Evaluation of Potential Kidney Donor with Recent Travel-Related Gastroenteritis

A potential kidney donor who developed viral gastroenteritis or foodborne illness while traveling abroad can proceed with donation in 40 days, provided they complete comprehensive infectious disease screening at least 2-4 weeks after return from travel (allowing adequate time for seroconversion), with all testing finalized within 28 days of the scheduled donation. 1, 2

Critical Timing Requirements

The 40-day window between illness and donation is generally adequate, but specific timing protocols must be followed:

• Minimum waiting period: Testing should occur at least 2-4 weeks (14-28 days) after return from travel to allow adequate time for potential infections to become detectable and avoid false-negative results during the "window period" 1, 3
• Maximum testing window: All infectious disease screening must be current within 28 days of the actual donation surgery 4, 1, 2
• Optimal testing timeline: Perform screening approximately 2-3 weeks after return, which allows seroconversion while staying within the 28-day pre-donation requirement 1

Mandatory Infectious Disease Screening

Standard Testing (Required for All Donors)

• HIV 1/2: Antibody testing via enzyme-linked immunoassay (EIA), with nucleic acid testing (NAT) reducing window period to 5-10 days 4, 2
• Hepatitis B: Surface antigen (HBsAg) and total core antibody (HBcAb) testing 4, 2
• Hepatitis C: Antibody (HCV) testing with NAT if indicated 4, 2
• Syphilis: Rapid plasma reagin (RPR) testing 4, 2
• CMV and EBV: IgG serologies to guide post-transplant prophylaxis strategies 4, 2
• Urinalysis: To detect asymptomatic urinary tract infections 1, 3

All HIV, HBV, and HCV screening must be performed or updated within 28 days of donation. 4

Additional Testing Based on Travel History and Symptoms

Geographic-Specific Screening

The country of travel determines additional required testing:

• Parasitic infections: Stool examination for ova and parasites is essential for donors with recent travel to endemic regions 1, 3
• Malaria: Consider testing if the donor visited rural areas in malaria-endemic regions 1, 3
• Arbovirus testing: Required if symptomatic (dengue, chikungunya, Zika) 1
• Tuberculosis: Purified protein derivative (PPD) skin test should be performed for donors coming from endemic areas 4
• Endemic fungal infections: Testing may be necessary depending on specific regions visited 1

Gastroenteritis-Specific Considerations

For donors with recent gastroenteritis or foodborne illness:

• Stool cultures: Should be obtained if diarrheal symptoms were present to rule out bacterial pathogens (Salmonella, Shigella, Campylobacter, pathogenic E. coli) 1
• Parasitic evaluation: Multiple stool examinations for ova and parasites, particularly for travel to developing countries 1
• Resolution of symptoms: Donor should be completely asymptomatic with normal bowel function before proceeding 4

Risk Assessment Framework

Absolute Contraindications to Donation

• Active infection at time of donation: Presence of active infection precludes donation 5
• HIV-positive status: Absolute contraindication except when donating to HIV-positive recipients under specific protocols 2
• Hepatitis C viremia: HCV NAT-positive donors contraindicated except for HCV-positive recipients 4, 2
• Active hepatitis B: HBsAg-positive donors generally contraindicated except for matched recipients 2

Acceptable Risk with Appropriate Management

• Resolved gastroenteritis: Not a contraindication if symptoms have completely resolved and screening is negative 4
• CMV/EBV-positive donors: Acceptable with tailored prophylaxis for seronegative recipients 2
• Treated syphilis: Acceptable with appropriate recipient treatment 2

Documentation Requirements

Complete documentation must include:

• Detailed travel history: Specific countries, regions, and cities visited; dates of travel and return; accommodations and food/water exposures 1, 3
• Illness details: Onset, duration, and severity of gastroenteritis symptoms; any medical treatment received; complete resolution date 1
• All screening results: Baseline and travel-specific infectious disease testing with dates performed 1, 3
• Risk assessment: Formal evaluation by transplant team and infectious disease consultation if indicated 4, 1

Critical Pitfalls to Avoid

Testing Timing Errors

• Testing too early: Performing infectious disease screening immediately after return from travel may miss infections in the incubation period, resulting in false-negative results during the window period 1, 3
• Testing too late: Failing to complete all testing within 28 days of donation violates mandatory screening requirements 4, 1

Inadequate Geographic Risk Assessment

• Overlooking endemic infections: Failing to screen for geographically restricted infectious agents endemic to the travel destination can lead to donor-derived infections with significant morbidity and mortality for immunosuppressed recipients 1, 6
• Insufficient specialist consultation: Not consulting infectious disease specialists when evaluating donors with travel to endemic regions leads to inadequate risk assessment 1, 3

Incomplete Symptom Evaluation

• Premature clearance: Proceeding with donation before complete symptom resolution and negative screening may transmit infection 4, 5
• Inadequate stool evaluation: Single stool examination may miss parasitic infections; multiple specimens increase diagnostic yield 1

Recommended Action Plan for This Donor

1. Week 2-3 post-return (approximately day 14-21): Perform comprehensive infectious disease screening including standard panel plus travel-specific testing 1, 3
2. Confirm symptom resolution: Document complete resolution of gastroenteritis with return to normal bowel function 4
3. Review all results: Transplant team evaluates all screening with infectious disease consultation if any concerns 4, 1
4. Final clearance: If all testing negative and symptoms resolved, donor can proceed with donation at day 40 as scheduled 1, 2