Abstract Bartonella quintana is a louse-borne intracellular bacterium that remains a neglected cause of bacteremia, bacillary angiomatosis, and infective endocarditis among individuals experiencing poverty. In October 2023, Health Canada notified Canadian organ transplantation programs of an outbreak of donor-derived B. quintana infection. From March to August, 2023, five cases of donor-derived B. quintana disease were acquired in Alberta, Canada from three deceased donors who had experienced homelessness. Similar cases have recently occurred in the United States: two kidney transplant recipients were infected with B. quintana derived from a common donor with a history of unstable housing. In this paper, we discuss strategies to screen organ donors and monitor transplant recipients for B. quintana infection using epidemiologic risk factors, physical examination signs, and laboratory diagnostic tests. We review the limitations of existing diagnostic tests for B. quintana and describe how these problems may be magnified in the organ transplantation context.