Evaluation of potential solid organ donors in São Paulo, Brazil: Reasons for non-donation and the impact of infectious causes

Background Solid organ transplantation is a life-saving therapy for patients with end-stage organ disease; however, the persistent imbalance between organ demand and supply substantially increases waiting-list mortality. Expanding the donor pool is essential but must be balanced with safety and minimization of infectious risk. This study aimed to describe the main reasons for organ non-donation, with a particular focus on infectious causes, and to identify factors associated with procurement failure.Methods We conducted a retrospective cohort study using secondary data from the Organ Procurement Organization at Hospital das Clinicas, University of São Paulo, from 2019 to 2023. Monthly rates of donor exclusion due to infectious causes were evaluated, with comparisons between pandemic and non-pandemic periods. Factors associated with non-donation due to infection were assessed using Poisson regression with robust variance. The COVID-19 pandemic period was defined as March 2020 to March 2022.Results A total of 2591 potential solid organ donors were evaluated. Medical contraindications were the leading cause of non-donation, predominantly driven by infectious causes. The proportion of infection-related non-donation increased significantly during the pandemic compared with the non-pandemic period (45.3% vs. 28.2%; p Conclusions Infectious diseases represent a potentially modifiable cause of non-donation. These findings highlight the need for continuous reassessment of donation-related infectious risks and evidence-based donor infection management to prevent unnecessary organ loss.