Top 5 Takeaways

  1. Exemption for Certain Pediatric Transplant Candidates: Children under 12 years old who have undergone postnatal infectious disease testing are now exempt from pretransplant testing for HIV, HBV, and HCV during hospital admission, addressing concerns over blood volume loss.
  2. Background and Need for Update: The U.S. Public Health Service (PHS) revised its 2020 guidelines due to the low incidence of HIV, HBV, and HCV in children and the potential risks associated with blood loss from testing in pediatric transplant candidates.
  3. Data Review and Stakeholder Consultation: Reviews of CDC and Organ Procurement & Transplantation Network data, along with feedback from the transplant community, informed the updated recommendation.
  4. Incidence Rates Informing the Update: Low incidence of HIV, HBV, and HCV infections among U.S. residents under 20 years old, with a notable low risk in children under 13, underpinned the guideline revision.
  5. Continued Post-Transplant Testing: Despite the exemption for pretransplant testing, all transplant recipients, including those under 12, should still be tested for these infections 4-6 weeks post-transplant.

Original Article Author and Citation

Corresponding Author

Rebecca J. Free,

Suggested Citation

Free RJ, Levi ME, Bowman JS, et al. Updated U.S. Public Health Service Guideline for Testing of Transplant Candidates Aged <12 Years for Infection with HIV, Hepatitis B Virus, and Hepatitis C Virus — United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:844–846. DOI:


This MMWR article details the 2022 update to the U.S. Public Health Service guidelines regarding pretransplant testing for HIV, HBV, and HCV in children under 12 years. The update exempts these children from testing at the time of hospital admission for transplant if they have received postnatal infectious disease testing. This change aims to minimize unnecessary blood volume loss and the associated risks for these pediatric patients while maintaining rigorous standards for organ safety and infectious disease prevention.


The CDC and HRSA reviewed surveillance data for HIV, HBV, and HCV infection rates among U.S. residents, specifically focusing on those under 20 years of age, and data on age and weight distributions among U.S. transplant recipients from the OPTN. Consultation with the transplant community and a review of public comments also informed the guideline update.


The decision to update the guidelines was influenced by low incidence rates of these infections in children under 13, the specific health risks associated with pretransplant testing in pediatric patients, and the goal of aligning with other transplant-related policies. The update was made with careful consideration of maintaining organ safety and the overall health of the transplant candidates.


The updated PHS guideline reflects an evidence-based, risk-informed approach to pediatric transplant pretesting protocols, emphasizing patient safety and the practicalities of testing in young children. It also illustrates the ongoing commitment to adapt public health policies in response to evolving data and community feedback.

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