The High Council of Public Health (HCSP) comments on the relevance of investigations – upstream of organ or hematopoietic stem cell (HSC) donations – on infestation by Strongyloides stercoralis, the parasite responsible for strongyloidiasis. This opinion follows the death of two patients transplanted in France in 2022 with organs from a donor who was chronically infested with this parasite. After general data on strongyloidiasis, its risk factors, the diagnostic means available and elements of treatment (with the notion of effective and well-tolerated drug therapy), the opinion proposes a review of the literature on cases of contamination after organ transplantation reported over a period of 40 years (39 recipients contaminated by 27 donors), a review of the two recent French cases at the origin of the referral and an evaluation of the prevention actions implemented in different countries. In view of this data, the HCSP recommends the following measures:

• in candidates for a solid organ transplant, an ELISA-type serology for strongyloidiasis must be systematically integrated into the pre-transplant follow-up; in the event of a positive result, appropriate treatment must be carried out, if possible before transplantation;
• in living organ donors, an ELISA-type serology for strongyloidiasis must be part of the systematic pre-donation assessment; in the event of a positive result, oral treatment with ivermectin must be prescribed to the donor before donation;
• in deceased organ donors, an ELISA-type serology for strongyloidiasis must be part of the systematic assessment of the serum collected as close as possible to the day of organ harvesting; the serology results must be communicated within 10 working days following transplantation to the transplant team; in the event of positive serology in the donor, oral treatment with ivermectin must be implemented in the recipient as soon as the serological result is known;
• no recommendation for other products of the human body, except that a systematic strongyloidiasis serology must be done as part of the pre-transplant assessment in future HCT recipients, with treatment before the transplant with ivermectin in the event of a positive result.