Rabies-infected organs kill transplant patients

Within weeks of surgery, three recipients die

July 02, 2004|By Erika Niedowski | Erika Niedowski,SUN STAFF

Three transplant patients who received organs from an Arkansas man unknowingly infected with rabies died of the disease themselves last month, in the first known case of the lethal virus being passed on through organ transplantation.

The donor's organs were removed in Texas and screened for eligibility, then transplanted May 4 into patients at the University of Alabama-Birmingham Hospital and Baylor University Medical Center in Texas.

Within weeks, the three recipients of the man's liver and kidneys developed symptoms of rabies - including lethargy, seizures and other neurological problems - and died. A fourth patient exposed to the virus in a donated set of lungs died of complications during surgery.

Though rabies has been passed on eight times through corneal transplants, health officials said this is the first time it has been reported through organ donation.

"This has never happened before, but we need to do whatever we can to prevent it from happening again," Dr. Mitchell Cohen, director of the Centers for Disease Control and Prevention's Coordinating Center for Infectious Disease, said yesterday. The victims were infected with a strain of rabies commonly found in bats, he said.

The CDC is working with health officials in Alabama, Arkansas, Texas and Oklahoma - where the donor and recipients lived or were treated - to determine whether anyone with whom they had contact needs rabies shots. Person-to-person transmission has been documented twice, in Ethiopia: once from a bite, once from a kiss.

In the United States, there are typically three or fewer cases of human rabies each year, usually the result of a bite from a raccoon, bat or other infected animal. Treatment, which includes a vaccine, is effective only before the onset of symptoms. After symptoms occur, death typically follows within days.

Cohen said there was no evidence that the organ donor, who was not identified, had rabies when he visited Christus St. Michael Health Care Center in Texarkana, Texas. He had a fever and a severely altered mental state, and doctors diagnosed him with a brain hemorrhage. He died within 48 hours.

"Rabies would not have been thought of as the likely cause of his illness," said Cohen.

The man's organs were tested for HIV, hepatitis B and C and other diseases, Cohen said, but not for rabies because that is not part of the regular screening process. Once the current investigation is complete, he said, officials will determine whether a change in screening procedures is warranted.

In some states, including Maryland, transplant coordinators ask the families of potential donors whether the person was ever bitten by an animal suspected of carrying the disease. It is unclear whether that happened in this case.

Dr. Stephen T. Bartlett, a transplant surgeon at the University of Maryland Medical Center, said that blood tests and questionnaires can reduce but not eliminate the possibility of passing on an infection - even a rare one such as rabies.

"Viruses known and unknown can be transmitted, and cancers can be transmitted," he said.

But Cohen stressed that the likelihood is extremely low, and that transplants save thousands of lives each year. "The consequence of not receiving a donation far outweighs the risk of acquiring a disease," he said.

Sun staff writer Jonathan Bor contributed to this article.

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