Maryland Transplant Patient Dies of Rabies

A patient in Maryland has died of rabies contracted from a kidney transplant, and three other people who received organs from the same donor were being treated to prevent the disease, health officials said Friday.

The patient’s sex and date of death were not disclosed.

Doctors did not know or even suspect that the organ donor had rabies, so he was not tested for the virus that causes it before his heart, liver and kidneys were removed for transplantation.

This was the second time in the United States that transplanted organs have spread rabies, said Dr. Matthew J. Kuehnert, the director of the Office of Blood, Organ, and Other Tissue Safety at the Centers for Disease Control and Prevention. The first was in 2004, when three people who received organs from one donor died of the disease. A fourth recipient died, but so soon after surgery that the death was not thought to be a result of rabies.

Infections of any type spread by transplanted organs are uncommon. Fewer than 1 percent of deceased donors are found to have infected recipients, says the Organ Procurement and Transplantation Network, which oversees transplants nationwide. But when infections occur, they can be deadly, because drugs used to prevent patients from rejecting transplants work by suppressing the immune system — leaving them vulnerable to infection.

Transplant specialists walk a fine line. Organs are scarce and doctors are loath to discard anything that could save a life. Time is of the essence: once a donor dies, the organs start to deteriorate and must be used quickly.

Extensive testing is done for H.I.V., hepatitis and other diseases, but cannot be done for every possible infection. Rabies is rare, and donors are not tested for it unless there is reason to suspect it.

The rabies cases highlight a particular dilemma: whether to use organs from people who die of poorly defined neurological disorders. It is not known how many patients fall into that category, Dr. Kuehnert said.

In some cases, people thought to have had strokes or other noncontagious brain problems that would make them ideal donors turned out to have infections that were transmitted to recipients. Rabies and amoebic infections were among the diseases that killed transplant recipients. West Nile virus also caused deaths in the past, but donors are now screened for it.

In the latest rabies cases, the donor died in Florida in 2011, and his organs went to recipients there and in Georgia, Illinois and Maryland. More than a year passed before one of the recipients — the patient in Maryland — became ill with rabies and died (the disease can have a long incubation period).

The rabies was a strain found in raccoons. Because the patient had no known exposure to animals, doctors wondered if the transplant might have been the source. Tissue samples from the donor had been stored, and tested positive for the same strain of rabies that killed the recipient.

Health officials immediately called the other three recipients. None were ill. All were being given rabies vaccine and immunoglobulins.

The C.D.C. was also trying to track down health workers and others who had been in contact with the donor and transplant recipients, and who might also require preventive treatment.

In June, the organ network issued advice to doctors on how to recognize central nervous system infections in potential organ donors. It recommended looking for fever and abnormalities in the spinal fluid, and double-checking records to see which diagnosis seemed more logical based on a donor’s age and medical history — an infection or a stroke.

News Source: www.nytimes.com