Introduction: The incidence of infective endocarditis (IE)-related hospitalizations has risen over the past decade in the United States.  While organ donation from patients with IE is not contraindicated, it requires careful evaluation of the pathogen, treatment history, and potential for infectious transmission.  Donors with septic emboli pose additional complexity and remain poorly characterized in the literature. We describe successful abdominal organ recovery from a donor with IE complicated by multiple embolic events. 
Method: Between 9/2022- 5/2024, our organ procurement organization (OPO) received 43 referrals of patients with infective endocarditis.  Organs were subsequently recovered from nine donors with confirmed endocarditis, eight of whom had radiographic evidence of septic emboli.  We report in detail one representative case involving a 34-year-old male donor with congenital heart disease, a mechanical heart valve, and a pacemaker who developed septic emboli in the setting of methicillin-sensitive Staphylococcus aureus (MSSA) mitral valve endocarditis.  
Results: The donor presented with fever, vomiting and altered mental status.  Brain imaging revealed a left parietal intraparenchymal hemorrhage (IPH), a 4mm abnormal enhancement concerning for mycotic aneurysm, and vascular cutoffs consistent with septic emboli.  Trans-thoracic echocardiography demonstrated mitral valve vegetations. The patient was started on empiric antibiotics (vancomycin, piperacillin-tazobactam, and metronidazole), later narrowed to cefazolin and rifampin upon MSSA identification from blood cultures. On hospital day 6 the patient suffered an acute decline in the setting of enlargement of the IPH.   Further imaging revealed bilateral pulmonary nodules, a right lower lobe wedge-shaped consolidation, splenic infarction, and a small right renal infarct.  These findings were all consistent with septic embolic phenomena.  Despite clinical stabilization, the patient declined neurologically and was declared brain-dead on hospital day 10. After multidisciplinary review involving the OPO Infectious Disease Medical Director, abdominal organ recovery proceeded on hospital day 11.  The liver and left kidney were successfully recovered and transplanted into a 42-year-old male and a 62-year-old male, respectively. Both recipients remained alive with functioning grafts at two years post-transplant and had no reports of donor-derived infectious complications. 
Conclusion: Organ recovery from donors with infective endocarditis and septic emboli can be performed safely with rigorous evaluation.  Thorough assessment of the infection source, microbiology, antibiotic treatment, and embolic burden – in collaboration with a transplant infectious disease specialist – is essential to minimize risk to recipients. This case underscores the importance of individualized donor assessment and highlights an opportunity to expand the donor pool in a traditionally higher-risk patient population.