transplantation is not immediately life saving but instead aims to improve the quality of the recipient’s life, a greater margin of safety is appropriate. Nonetheless, transmission of infectious or other disease to recipients always remains a possibility, as there are limitations on diagnostic capabilities and limited time frames for donor assessment. It is important that the recipient has an informed view of accepting or rejecting an organ of lower quality and/or increased risk of disease transmission, with an understanding of the likely benefits from transplantation with the organ on offer (in terms of survival and/or quality of life), the likelihood of subsequent organ offers, and the risk of deterioration of their health status whilst waiting for an alternative offer. The conversation with the patient regarding consent to receive organs of lower quality or increased risk of disease transmission should occur early, ideally at the time of consent to waitlisting, and should be revisited periodically to take into account changes in patient priorities and health status. Suitability of a particular organ for transplantation is influenced by a range of factors including donor age, size, medical history (including co-morbidities), lifestyle choices and specific organ size and pathology. The donation pathway will also influence organ suitability; that is, suitability will be affected by whether the donation was via a DCD or DBD pathway, the cold ischaemic time, the warm ischaemic time in case of DCD, the surgical retrieval process, organ perfusion, organ storage and logistics. It is increasingly possible to grade the quality of donated organs in order to provide a more accurate prediction of the medium and long-term functional outcomes of the organ post-transplantation. It is also possible to grade the risk of transmissible disease associated with a given donor and organ. This grading of organ quality and risk of disease transmission allows acceptance decisions to be tailored to individual recipients’ needs. That is, the potential benefit that is offered by a given organ may be insufficient for the needs of certain individuals (for example patients who are stable on medical therapy), however the same organ may increase the quality of life and survival prospects of other wait listed individuals (for example patients who are deteriorating on the waiting list or who are older). 2.2.2 Medical and social history Obtaining a thorough medical, behavioural and travel history of the donor, performing a careful clinical examination and undertaking suitable investigations are critically important to the quality, safety and efficacy of organ donation. The accuracy of this information is critical to the assessment of the degree of risk to which the recipient of an organ from a given donor may be exposed. When interviewing next-of-kin and/or significant others regarding the history of a potential donor, it is important that this is done in a structured and standardised manner, utilising best practice tools, to balance the rigorous requirements of screening with compassion, patience and empathy. In Australia, the donor’s medical history, examination and investigations are captured in an electronic donor record (EDR), which is completed for all donors, with the relevant information components provided to transplant units when organs are offered for transplantation. In New Zealand, the donor’s medical history, examination and investigations are captured in a Confidential Donor Referral, which is completed for all donors, with the relevant information components provided to transplant units when organs are offered for transplantation. There are specific requirements for determining the suitability of each individual organ being considered for transplantation and these are identified in each organ-specific chapter. The general evaluation of donor suitability includes obtaining detailed information about the donor’s past medical and social history, paying particular attention to: • History of diseases and surgery, especially those that may affect organ function • History of diabetes, hypertension and other cardiovascular disease April 2021 version 1.5 9 • Smoking, alcohol intake and non-medical drug use • History of tumours or cancer—including stage, pathology details, treatment and current status • Recent symptoms that may be indicative of undiagnosed infection, neurological disease or malignancy • Suggestion of underlying metabolic disorder • Risk factors for the transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV), including non-medical injecting drug use, male to male sex, commercial sex work, time in prison, sex with a person at increased risk of these infections, a young child of a mother at increased risk of these infections, or diagnosis with syphilis, gonorrhoea, chlamydia or genital ulcers in the past 12 months • Risk factors for the transmission of Transmissible Spongiform Encephalopathies (TSE), including family history of early dementia, use of pituitary hormone extract, notification of treatment with pituitary hormone extract • Place of birth and prior residence in countries outside of Australia and New Zealand • Travel history, especially recent travel (past six months) • History of animal contact • History of COVID-19: it should be ascertained whether the donor has ever been tested for or diagnosed with COVID-19,