Due to various technical and methodological challenges, PISA has to date offered only limited accommodations for students with special education needs (SEN). As a result, some students are currently excluded from the PISA target population at the sampling stage, and in some countries, exclusion rates are growing as more and more students are recognized as having disabilities that require testing accommodations. This practice in PISA contrasts with testing standards in many countries which call for the inclusion of students with SEN in order to give every student the right to demonstrate their skills and to generate information that represents all students. In order to take stock of the situation in terms of exclusions from PISA and accommodations already offered in national evaluations, we conducted a survey of PISA-participating countries and economies. This paper presents results from this survey and reviews the literature on effective accommodations in order to identify the priority needs to address in PISA, as well as promising accommodations that PISA could integrate to support these needs.