Rabies Linked to Eight Organ Donor Transplant Deaths: Study

A study published this week highlights the potential risk of rabies going undiagnosed among organ donors, which may result in death for individuals who receive infected organs.

Research published on Wednesday in the Journal of the American Medical Association (JAMA) identified at least eight deaths from rabies after organ transplant. The study involved a review of organ donor and transplant recipient medical records, with lab tests conducted on blood, spinal fluid and tissue samples from donors and recipients.

One particular case outlined in the study involved the death of a Maryland man who received a kidney from a donor who was thought to have died from ciguatera, which is blood poisoning caused by fish. The recipient became ill and died nearly 18 months after the transplant.

The donor initially showed symptoms of vomiting, tingling in his arms, fever, seizures and encephalitis; symptoms consistent with both rabies and ciguatera. Brain scans of the donor did not reveal encephalitis, leading doctors to make a misdiagnosis of ciguatera and determine that he did not have an increased risk of infectious disease transmission.

A postmortem autopsy of the recipient and donor confirmed rabies infection and concluded the organ transplant was the cause of transmission to the recipient. Researchers later determined the donor was bitten twice by rabid raccoons prior to his death and organ transplant, but both bites went unreported.

Other kidney, liver and heart transplants involving at least three different recipients were also outlined in the report. Follow-up of those patients and subsequent treatment has kept the recipients free of rabies to date.

Transplant Organ Infection Transmission

The long incubation period in the recipient makes these cases of rabies extremely unusual, yet researchers say this is an opportunity to raise awareness concerning rabies and organ transplant.

Rabies is extremely rare in the U.S. and kills roughly two people each year. Thousands are often exposed to the virus after coming into contact with rabid raccoons, dogs and bats; however drugs used to combat the virus are nearly 100 percent effective, according to the U.S. Centers for Disease Control and Prevention (CDC).

The researchers highlight the need for modified organ donor screenings and recipient monitoring for infectious encephalitis following transplant. Other incidents of infected organs transplanted to unknowing recipients also have raised questions about the organ donor screening process.

In 2011, the CDC drafted new guidelines aimed at preventing the transmission of infections through organ transplant surgery. The guidelines are meant to prevent the spread of HIV, hepatitis B, C and other infectious diseases and recommend more updated screening tests for organs.

More than 200 cases of suspected HIV, hepatitis B and hepatitis C transmission from organ transplants occurred from 2007 to 2010. Some cases, such as the case of the rabies infection, resulted in the death of the organ recipient.