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mosquitoborne disease in the contiguous United States and is spread to humans primarily by Culex species mosquitoes (1). Transmission through solid organ transplantation (SOT) and blood transfusion was recognized during 2002 (2,3). Patients infected by SOT are at increased risk for severe disease and death, probably related to immunosuppression (2,4– 11). In the United States, WNV screening of deceased organ donors is not mandatory and varies by organ procurement organization (OPO) (12). We describe WNV SOT transmission during 2018 and considerations for donor screening practices. The Study A man in his 60s who had diabetes mellitus, endstage renal disease, and hepatitis C virus infection underwent kidney transplantation during September 2018. Nine days after transplantation, he was hospitalized because of fever and progressive obtundation. Detection of serum WNV IgM prompted suspicion of donor-derived infection. The case was reported to the United Network for Organ Sharing/ Organ Procurement and Transplantation Network for investigation by the ad hoc Disease Transmission Advisory Committee and subsequent referral to the Centers for Disease Control and Prevention (CDC). The patient survived with no apparent neurologic defi cits. A recipient of a liver from the same donor was a man in his 30s who had alcoholism, hepatitis C virus infection, and cirrhosis. Sixteen days after transplantation, he became febrile and was hospitalized. He survived but had mild encephalopathy and peripheral neuropathy ≈1 month after transplantation. The organ donor was a woman in her 20s who had a history of intravenous drug use and was found at home during September in cardiopulmonary arrest attributed to drug overdose. She was resuscitated but later declared brain dead. The left kidney and liver were recovered for transplantation. Interviews of family members yielded discrepant reports about preceding symptoms. In organ donor’s state of residence, WNV human and equine disease cases, viremic blood donors, and mosquito infection rates were increased during 2018 compared with previous years. Organ donor and recipient specimens were tested by state public health and commercial laboratories West Nile Virus Transmission by Solid Organ Transplantation and Considerations for Organ Donor Screening Practices, United States