or has been in close contact with a person known to have confirmed, probable or suspected COVID-19. Information required regarding the donor’s current medical status and recent medical history includes: • Course of illness and cause of death • Vital signs and cardio-respiratory status, including mechanical and pharmacological supports • Function of potentially transplantable organs, including pathology, microbiological tests and imaging results • Surgery or other procedures • Medications • Administration of intravenous fluids and blood products (noting especially that haemodilution from large volume intravenous fluid may result in false negative serological test results). There are very few absolute exclusion criteria to organ donation, with the exception of disseminated metastatic cancer and donors with known specified factors for TSE (see Section 2.3.5.1). All other risk factors should be interpreted in the context of all other donor characteristics and recipient factors. 2.2.3 Physical examination Physical examination provides information relevant to suitability, allocation, and possible disease transmission risks. This should include: • Height and weight • General assessment with respect to body habitus and state of health, major abnormalities related to past or present disease (e.g. obvious limb ischaemia, chest or spinal deformities, traumatic injuries) • Inspection of skin, including the skin of the back and careful examination in skin folds and around the genital and anal areas, looking for surgical scars, skin lesions indicating possible cancers or infections, injection sites/needle track marks suggesting intravenous drug use (IVDU), or lumps, sores, tattoos or rashes • Palpation for obvious lumps and masses (e.g. neck, groin, axillae, breasts, abdomen). An additional physical examination by an experienced surgeon(s) at the time of retrieval is also important, as this may reveal unexpected clinically occult lesions such as bowel cancers or renal or liver tumours. April 2021 version 1.5 10 2.2.4 Laboratory investigations Blood group for ABO and Rhesus are mandatory investigations for all donors. For women of child-bearing potential dying from unexplained intracerebral haemorrhage, testing for beta human chronic gonadotrophin hormone is recommended to detect metastatic choriocarcinoma. Whilst routine post mortem examination has become an uncommon procedure in clinical medicine, if an autopsy is performed then the results should be followed-up by the donation service up as the autopsy may detect potentially transmittable disease. The list of possible pathogens for which potential donors might be screened is very long. Which of these pathogens to screen for depends on whether: • The pathogen is sufficiently prevalent in the population that screening would be useful • There is evidence that the pathogen in question can be transmitted by organ transplantation • Transmission of the pathogen could result in significant morbidity or mortality • A sufficiently accurate, rapid and affordable screening test exists. The rapid turn-around times necessary in the context of donor screening, the associated logistical and technical limitations, and the need to balance the risk of transmission of infection against the risks to the recipient of dying while awaiting transplantation, make the goals of screening potential organ donors different to screening blood or tissue donors. It is the goal of organ donation and transplantation programs to minimize unexpected infectious disease transmission events while simultaneously maximizing opportunities for transplantation. All infectious disease screening recommedations, therefore, carefully consider turn around times, test performance (i.e. the potential for false positive or false negative results), and other logistical issues that may pose a risk to the donation process and lead to the loss of transplantable organs. These considerations must be weighed against the benefits of screening to patient safety. The following laboratory investigations to detect infections that may be transmitted by solid organ transplantation are recommended for all donors: • HIV antigen/HIV-1/2 antibody combination assay (HIV Ag/Ab) • Hepatitis B surface antibody (anti-HBs or HBsAb) • Hepatitis B surface antigen (HBsAg) • Hepatitis B core antibody (HBcAb) • Hepatitis C antibody (anti-HCV or HCV Ab) • Nucleic acid testing (NAT) for HBV, HCV and HIV, most commonly using polymerase chain reaction (PCR) assays • Cytomegalovirus (CMV) immunoglobulin (IgG) antibody • Epstein-Barr virus (EBV) capsid IgG antibody • Syphilis serology (specific treponemal antibody test) • Toxoplasmosis serology (IgG) • Human T-cell-lymphotrophic virus (HTLV) 1/2 antibody • NAT for coronavirus (SARS-CoV-2) on respiratory tract samples using a PCR assay. Urine microscopy and culture is recommended for all donors from whom a urine sample can be obtained, with the results of cultures and sensitivity testing to be followed up as soon as they become available (which may not be until after transplantation has occurred). Blood cultures are recommended only if there is clinical suspicion of bacteraemia. Respiratory tract samples (e.g. tracheal aspirate, sputum or bronchoscopic samples) for microbiological testing should be collected for lung donors or if respiratory infection is suspected. Table 2.1 provides details of which donors should receive the tests specified