Purpose of Review <p>The aim of this review is to provide a comprehensive update on the management, screening, prevention and treatment of Chagas disease in solid organ transplantation.</p> Recent Findings <p>Global migration has extended the relevance of <i>Trypanosoma cruzi</i> infection beyond endemic regions, making systematic risk assessment essential in transplant programs.</p> <p>An increasing body of evidence supports the safety and feasibility of transplanting kidneys and livers from <i>T. cruzi</i>–infected donors into seronegative recipients, (thereby expanding the donor pool) provided that structured post-transplant surveillance is implemented. Likewise, all types of solid organ transplantation can be performed in <i>T. cruzi</i>–infected recipients, although immunosuppression increases the risk of reactivation.</p> <p>For optimal outcomes, standardized qPCR-based surveillance provides the strongest evidence for early detection and management of donor-derived transmission or reactivation, enabling patient and graft survival rates comparable to those of non-Chagas recipients.</p> <p>However, validated parasitic load thresholds predicting progression to symptomatic disease are lacking, and most monitoring strategies are consensus-based rather than supported by prospective trials.</p> <p>When transmission or reactivation occurs, trypanocidal treatment with benznidazole or nifurtimox is generally well tolerated and highly effective. Unmet needs persist, particularly the development of validated biomarkers to assess treatment response and test-of-cure.</p> Summary <p>Solid organ transplantation in patients at risk for Chagas disease can be performed safely with appropriate screening, structured monitoring, and timely treatment. Further prospective studies are needed to strengthen the evidence base guiding transplant-specific management strategies.</p>