In the case of the rabies organ transplant, there is more news that only serves to bring the poor organ testing practices to light. The Air Force recruit who lost his life and had his organs subsequently donated apparently suffered from at least two raccoon bites several months before he was sick. Tests confirmed that the kidney was infected with rabies when it caused the recipient to become fatally ill.
Initially, doctors determined that the donor died from other causes, but an investigation initiated by the death of the kidney recipient in February found evidence that there was rabies in the brain tissue of the donor, as well as encephalitis, which is inflammation of the brain that can be due to rabies.
The virus, consistent with raccoon rabies, was almost identical to the virus found in the transplanted kidney, as well as in other tissues from the recipient, who was an Army veteran that came from Maryland. The report was put together by researchers at the federal CDC, in conjunction with others before being published on Tuesday in the Journal of the American Medical Association.
Authorities aren’t certain if the organs that were given to three additional patients, a heart, liver and the second kidney are infected with rabies, but all three of them are thought to be at risk. To date, the recipients “remain well,” as they received anti-rabies treatment.
Although this is an unusual case, it emphasizes the need for better screening of potential organ donors where encephalitis is suspected. According to the authors of the report, a standard questionnaire for donors could be helpful in identifying virus risk factors. The report also says that donors with unexplained encephalitis should be considered for rabies.
Last year, the United Network for Organ Sharing issued guidelines to help organizations that procure organs to screen for central nervous systems such as encephalitis in possible donors. It also urged that the organizations be extremely cautious about accepting organs that come from donors that have untreated central nervous system infections.
Researchers are working to improve the awareness that rabies can cause encephalitis, says Dr. Sridhar Basavaraju, co-author of the study and CDC researcher. He also said that they don’t want to mandate testing that could exclude organs that are transplantable.
The study bases its information on reviewing lab tests, as well as medical records and interviewing relatives of the recipient and the organ donor. It offers the most detailed look at the chain of events that caused the two deaths, as well as the following investigation, which caused authorities to recommend that dozens of people who had been in contact with the recipients and donor.
This case attracted so much attention because it was so rare, including the amount of time between infection and death of the organ recipient, which was about 18 months. According to the report, this was only the third documented case of rabies being transmitted through solid organ transplants.