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This document provides guidance for transplant practitioners on monkeypox (MPX) and organ transplants. We acknowledge that our current understanding of the disease is incomplete. This guidance will require revision as new evidence emerges. In these guidelines, we adopt a conservative approach to organ donation with regards to MPX transmission. We err on the side of safety. We recognize that many institutions already have experience with MPX. This document makes suggestions, but its aim is not to be dogmatic. Individual programs and patients should make their own decisions based on the clinical circumstances of the potential donor and the needs of the potential recipient, as well as their own experience with MPX disease.