The permanent gap between organ demand and supply has prompted use of organs from extended criteria donors (ECD). These carry a higher risk of disease transmission, with regard to infections and malignancies. We present herein the donor risk stratification algorithm implemented in Italy since 2004 for identification management of donor-to-recipient risk of disease transmission. The principles underlying this algorithm are: (1) the risk of disease transmission must be assessed against the potential benefit for the transplant recipient (i.e., no donor can be excluded from evaluation and their organs might benefit potential candidates); (2) patients awaiting organ transplantation must be informed that the risk of disease transmission is small but finite (standard risk); and (3) risk evaluation is an ongoing process based on information collected longitudinally after transplantation. Regional and national transplant authorities are committed to regular updating of guidelines based on clinical data derived from clinicians and on evaluation of posttransplant graft and patient survival rates.
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