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An electron micrograph image of rabies viruses. A Maryland kidney transplant patient died of rabies transmitted by the organ, federal officials say.
Rabies killed a patient who got a kidney transplant more than a year ago, federal officials said Friday. Now they are treating three other people who got a second kidney, a heart and a liver from the same donor – an Air Force recruit who apparently died of undiagonosed rabies.
The donor died in Florida, and the heart, kidneys and liver from the patient were transplanted into three other people, the Centers for Disease Control and Prevention said. The Defense Department said the donor was a 20-year-old recruit who had been in the Air Force for just under four months when he died in 2011.
Doctors did not suspect rabies killed the donor and did not test for the virus, the CDC said. "Rabies was only recently confirmed as the cause of death after the current investigation began in Maryland," the CDC said.
"Shortly before becoming ill, the donor had moved to Florida, but was a previous resident of North Carolina where it is believed the exposure may have occurred. How the donor may have gotten rabies is currently under investigation," the CDC said in a statement.
The agency is not naming any of the patients involved.
"In 2011, the donor became ill and was admitted to a healthcare facility in Florida and then died. At that time, the donor’s organs, including the kidneys, heart, and liver, were recovered and sent to recipients in Florida, Georgia, Illinois, and Maryland," the CDC said.
Potential organ donors in the United States are screened and tested for viruses, bacteria and other infections. But rabies isn't one of the usual microbes that is tested for, in part because the test takes too long and in part because rabies is so rare in people.
People can become infected with rabies without knowing it. It is transmitted in saliva -- which is why animal bites are dangerous -- and blood. But vaccination after a bite can prevent symptoms. Once a patient develops symptoms from rabies, it is almost always fatal.
Bats are the most common cause of rabies infection, while raccoons, skunks, and foxes are the most commonly reported rabid animals.
"CDC’s preliminary laboratory analysis indicates that the recipient and the donor both had the same type of rabies virus—a raccoon type. This type of rabies virus can infect not only raccoons, but also other wild and domestic animals. In the United States, only one other person is reported to have died from a raccoon-type rabies virus,' the CDC said. Genetic testing can reveal what strain of virus has infected someone and advanced testing that looks for genetic mutationscan show whether someone was directly infected by someone else.
"The three other people who received organs from the donor have been identified and are currently being evaluated by their healthcare teams and receiving rabies anti-rabies shots (immune globulin and anti-rabies vaccination)," the CDC said.
"CDC is working with public health officials and healthcare facilities in five states (Fla., Ga., Ill., Md., and N.C.) to identify people who were in close contact with the initial donor or the four organ recipients and might need rabies post-exposure treatment," the agency says.
Doctors perform 40,000 organ transplants annually worldwide. In 2011, a team at Northwestern University’s school of medicine estimated that fewer than 1 percent of all organ transplants also transmitted an infection.
More than 28,000 organ transplants are performed in the U.S. each year, while more than 114,000 people are waiting for organ transplants, according to the United Organ Sharing Network. In 2011, 6,669 people died waiting for organ transplants.
Organ donors are routinely tested for hepatitis viruses, HIV, a virus called HTLV that can cause leukemia, the syphilis bacteria, West Nile virus and the parasite that causes Chagas disease. But other infections have been transmitted by organ, tissue and other transplants – including the deadly brain disease called Creutzfeldt Jakob disease or CJD; herpes, cytomegalovirus and a variety of bacterial and fungal infections.
Rabies is also known to have been transmitted both by cornea transplants and organ transplants – most recently a batch of three organ recipients treated at Baylor University in Texas in 2004. Officials ended up treating hundreds of people who had been in contact with the organ donor and the recipients.
But last August, Melissa Greenwald, chief of the Tissue and Reproduction Branch at the Food and Drug Administration raised concerns about the lack of a systematic protocol for testing organs and tissue used for transplant.
“Disease transmission through organ and tissue transplantation has been documented. Recognizing emerging infectious diseases in organ and tissue transplantation is challenging because of nonstandardization of donor evaluations and data collection, pathogen characteristics, and recipient surveillance,” Greenwald and colleagues wrote in Emerging Infectious Diseases.
“Because organs, cells, and some tissue grafts cannot be subjected to sterilization steps, the risk of infectious disease transmission remains and thorough donor screening and testing is especially important.”
Organ recipients are especially vulnerable because they’ve usually been ill for along time, and then must take drugs to suppress their immune systems so their bodies will tolerate the donated organ.
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Years ago an episode of "Scrubs" had this very scenario. If scriptwriters could come up with this idea, why hasn't a reliable screening method for rabies in potential donors been developed?
I have it on good authority that the God of Abraham (YHVH) has an answer for those praying for a cure after being infected with the rabies virus: NO. These requests follow the same policy outline that the Almighty has for amputee limb regrowth requests: NO.
YHVH will, however, keep an open mind when it comes to answering yes or no as it relates to the outcomes of sporting events, excema remissions, and shetland pony sales.
Now, go forth and breed no more.
+Francis, acting pope.
Lighten up, Francis.
You need to adjust your meds.
Thank you for the advice! I have only one leg and I want a pony.
Pikkewyntjie,
Don't call him Francis!!!
OMG...I crack myself up.
And people are worried about the bogeyman with the gun. Many more people die from medical infections doctor errors and medicine mismanagement then firearms. THIS is far more likely to happen to you then someone shooting you. Media blowing firearm deaths out of proportion as compared to real threats like this. Lets place the fear in the proper place folks.
the above comment is ignorant
Just love that modern medicine. Die with rabies and have your organs transplanted and no one even bothered to check. "I don't feel well and I'm foaming at the mouth, I feel kinda off" Right this way sir so we can harvest those organs and make a little money. Just fill out these forms and let's get you prepped.
this is an absurdly ignorant comment.
yeah, easy to say after the fact. Where were you last week? How many times BEFORE today did you decry that lack of a rabies screen on transplanted organs?
Secondly, this is news because it is rare. EXTREMELY rare. And testing (and waiting) for rabies on every transplanted organ would cost valuable time where hours make the difference between a viable graft and a wasted organ. Routine testing would cost more lives than it would save
I wish medicine were that easy. Keep dreaming and watching grey's anatomy. You live in a fantasy land
Organ transplants aren't the biggest money makers on the block, if they even make money at all. They require huge multispecialty teams and a literal army of people on call day and night. That ain't cheap.
Furthermore, the docs who do this are on call 24/7 for transplants. They could easily be making more money with less hassle on scheduled daytime procedures. They do transplant because they believe in it.
Lets see you give up a nights sleep at least a few times a month to save a life, and see if you do that for free...
One almost "assumes" that a donor will be checked for rabies.
why?
eric, the "protector" of all dr./hospital/medical screwups, lack of care, lack of diligence, etc.
Presumably there are dozens and dozens of diseases an organ can carry, but do we test for all of them? Is there time? Rabies is such a rare disease, and apparently the test takes a long time, and some donors don't even show any symptoms, that it may not be practical to test 28,000 organs annually for it. Organs have a very short lifespan outside the body.
stop,
are you capable of forming a coherent thought? If so, by all means, share it.
If not, then just STFU.
As liver transplantee, lessee, what were my options?
1) die from liver disease
2) possibly die from transplanted liver disease
Option 2 still seemed best.
1) Rabies testing can take 1 - 8 days organs dont last that long; 2) there are ony 2-3 deaths per year from rabies ( a total of less than 50 since 1995),; 3) if anyone read the article the donor was apparently asymptomatic for rabies - they didn't know what he died from.
When you hear hoofbeats look for horses not zebras. And if you have a pile of hose@!$%# there must be a pony somewhere.
The could test for Rabies after the organ has been transplanted. It usually takes 30 days or more for some one to develop rabies after being infected. The vaccine doesn't take 30 days to become effective.
My big question is why was that persons organs even harvested in the first place? Some one drops dead from an unknown illness yet they still harvest his organs? Maybe it was some unknown virus as deadly as Ebola. who knows? Lets just harvest his organs anyway. Seems common sense got thrown out in the desire to get more organs in the pipeline.
eric
How about at least knowing what the donor died of. Before you start sending parts of them all over the place. That should be a given. Geezzz, he didn't come in after being hit by a bus. He came in felling sick and died.
The article states they don't test for rabies because it takes to long. Too long for what? Too long to wait for results is what they mean. But does not take too long to save the recipients life. That is what we cal a "convenient rationalization." They knew something killed the donor, that is all they needed to know. Until they knew what disease it is, no transplants should have been done.
"In living humans, several tests are required to diagnose rabies because no single test is sufficient. Samples of saliva, serum, spinal fluid, and skin biopsies of hair follicles at the nape of the neck are all tested."
Testing would take too long for the organs to remain viable.
When it is your time, it is your time. If every donor were to be tested, only those in coma-like state would be eligible donors. Very rare, and there is no safety guarantee for anyone or anything. None of us make it out of here alive.
JBA-
The donor probably died of cardiac arrest. The cause could have been anything, but since he/she did not show any symptoms of rabies(or it sounds like anything else, really), why would they assume that he/she did not die of something normal. It's called Occam's Razor, which was unfortunately not the case here.
He was sick, was hospitalized, and went downhill to death. Even if he did not have typical neurological symptoms, given that he was a previously normal 20-year-old, the possibility that this was caused by some kind of infection should have been considered. I wonder if it will turn out later that any of the doctors on scene raised that possibility and were told by their administration to shut up because organs are quite profitable.
@ Jane,
And where does it say that the donor was a 20 year old, or even that he was normal for that matter. Stop making things up.
What DID they list as cause of death on his certificate. Because they found out a year later it was actually rabies. What causes present symptoms equal to rabies ? Anybody see the Article in TIME about what really is happening in medicine ?
i don't know exactly but sounds like they thought it was encephalitis
lots and lots of things
no
Heh! Billall, the Asspciated Press reported that the index case was 20 and that he'd been training as some sort of mechanic for the Air Force (which I would assume would not have taken him had he been terminally ill or severely handicapped). Stop throwing tantrums when the facts don't please you.
It is sad that this has to happen, but they should run a story every time a successful transplant occurs.
Every time? Real news is supposed to be about something popular or out of the ordinary. while a successful organ transplant IS an example of modern medical technology at its finest, a death by RABIES is out of the ordinary and how the victim was infected is REALLY out of the ordinary.
The donor died of rabies and nobody figured that out? How terrible for the donor-misdiagnosed with a fatal virus. He or she must have suffered horribly.
I know right? Unbelieveable. Maybe the donor contracted rabies and coincidently died of something else before rabies took hold. Shocking horrible story in any case.
Yea. that'll come back to bite you.
o.k that was good. LOL!!
Fawna,
That's funny stuff!!! I don't care who you are.
Only in Florida.................................they were over 70 and expendable. They also only had Medicaid.
Actually, the rabies virus manifests itself in many different ways. It can be confused with other life threatening diseases. Unless someone specifically tells the doctors "oh by the way, I was bitten by a ______" (fill in the blank), they will never even THINK of rabies.
They should test for everything under the sun if they are going to be putting an organ from a DEAD person, investigate the cause of death was BEFORE handing out the organs. Feel sorry for the others.
I don't fell the least bit sorry for the organ recipient, a human life ended prematurely and they we gracious enough to offer you their organs to stave off your death and you feel entitled to complain if it is not perfect. Beggars do not have the luxury of being choosy, take what you are offered and be grateful for whatever time it allowed you to have.
Wow, where to start?
First, I'm thinking if I worked with you I would be the "aggravated office worker" (you spelled aggravated incorrectly buy the way).
Second, I don't think anybody "feels entitled to complain", since the person in question is DEAD.
Third, donor recipients don't typically "beg" for the organs. They are on a list...when a person dies, IF they are an organ donor (which is voluntary), the sick person has to a) be first on the list, and b) have the right blood types.
Personally, I'm an organ donor, but if I knew your real name I'd put it in my living will that if, by chance, you are waiting for something, your name is skipped.
OK spelling nazi - it is "BY the way," and not "BUY the way."
And thanks also for that answer MPA...only I don't have the word in my name :)...
Unfortunately no surprise here. See blog I wrote last year "Undiagnosed Human Rabies Deaths?"
Also see "Rabies Outbreak in Westchester County and the Connection to Feral Cats"
TNR: The problem with what you are saying is that you are encouraging open season on any outside cat. In the area I live in, people from the city drive out and dump their unwanted cats. They are fixed, have shots, etc. People in this community are working with humane societies to take those that are adoptable and adopt them and the cats that are truly feral are trapped and given ALL SHOTS. If they are determined to be carrying disease, they are put to sleep.
A person who comes into contact with a truly feral cat without specifically looking for them is less than .001% of the population.
ALL donors should be screened for rabies. If it saves only ONE life it will be worth it.
We had a case of this here in Germany. The donor had been to India and she died in a car accident once she got back home. Apparently (only a guess) she had been infected by the saliva of a cow. These cows wander the streets shaking their heads spewing salivia. The cow had most likely been bitten by a bat. No one thought about a women dying in a car accident having rabies. I mean, sometimes terrible things happen. All of her organs were donated and all of the recipients died.
Rabies testing takes time - time that is not available if the donor is dead and the organs need harvesting (I hate that term). So to protect someone against the low incident of rabies (2-3 deaths per year) you are willing to waster organs and tissue. Or maybe hospitals should test everyone they admit for rabies, that way when a donor dies they have the results already - of course that adds to the cost of the hospitalization. How many people admitted to the hospital for a car accident would want to pay for routine rabies testing....
@ MG6789,
By screening all donors you will be killing thousands. The people on the waiting lists generally do not have time to wait and the rabies test takes too long to keep organs viable.
"Rabies is such a rare disease..." Ok, if it's so rare, what are the odds that someone donating organs would have it? Apparently not all that rare, given the incidents mentioned in the article about other occurrences. And given what a low percentage of people designate themselves as donors, what percentage of *them* must have it in order for this to happen multiple times? Just seems somewhat common for a disease that is supposed to be "rare" in humans.
its rare. Occurences get a lot of press. AS someone above mentioned, routine transplants don't get any press.
This was the subject of a particularly good episode ("My Lunch", 2006) of Scrubs. The donor was infected and the subsequent organ donation killed 3 more people.
yknow, thats the first thing I thought of when I read this article
The first thing I thought of was the Brazilian heart-transplanter in World War Z who used an organ from a Chinese prisoner. African rabies....
CSI had a similar episode.
FOlks testing organ donors for all possible diseases would be great - of course all that testing will take time, time that is not available if a physician wants to transplant fresh organs. The testing also costs money, and either the donor pays for the testing (or his insurance does as part of the treatment received - because all the medical bills accumulated prior to death do need to be paid), or the hosptial has to absorb the testing costs or the testing becomes part of the cost of the transplant.
Maryisa - the multiple cases in the article I suspect are from two donors - one in Tx and the other the donor from Fla. Donated organs go from one donor to multiple recipients.
Rabies is so rare that it would have been irresponsible to test for it while the other person was waiting to live.
(From scrubs haha)
scrubs...the most accurate medical tv show ever. Absolutely no sarcasm or exaggeration. Really.
All the rest are baloney.
Rare in this country do to vaccination compliance. Not rare in other parts of the world. India, last I checked, has upwards of 8,000 rabies deaths a year.
What I want to know is why isn't there a homeopathic rabies vaccine that all donors can be given?
/sarcasm
The AP is now reporting that the donor had been a healthy 20-year-old Air Force recruit when he "became sick"; the CDC also says he moved to Florida, "became ill", and died in a healthcare facility. It's understandable that the doctors didn't diagnose rabies; it's very rare and he had no reported animal bites. But shouldn't it have been intuitively obvious that a healthy young person who suddenly gets sick, develops neurological symptoms and dies might have had SOME type of infection, and that if they couldn't figure out what was killing him to confirm that it wasn't infectious, they ought not to have recycled his organs? Would any of them have wanted to be implanted with tissue from a person who had died of an unknown acute, rapidly progressive, untreatable disease? I kind of doubt it.
We keep seeing hints that transplant doctors think fully informed consent related to organ selection is not necessary. When people go on the transplant list, doctors assume - perhaps rightly - that they find natural death so totally unacceptable that they'd agree to anything to try to delay it, and therefore there's no need to actually get their agreement. So you have people unwittingly getting transplanted with the lungs of a lifelong heavy smoker and given immunosuppressants, then dying of explosive lung cancer. Those who favor recycling very dubious organs will say "They were going to die of their disease anyway; at least this gave them a chance of more time." True, but let's not forget that it also gives them a chance of more time in a hospital bed and more gigantic bills for the families left behind.
First: you use common sense. That is not allowed anymore.
Second: Read the Time Magazine article on the amount of money people make in the medical industry. That explains why common sense is not allowed.
In 2011, the donor became ill and was admitted to a healthcare facility in Florida and then died. At that time, the donor’s organs, including the kidneys, heart, and liver, were recovered and sent to recipients in Florida, Georgia, Illinois, and Maryland"
.... so they harvest organs from people who have died of unspecified illnesses? You'd think they'd want to know what the donor died from before implanting his cells in people and shutting off their immune systems.
Good thing the donor didn't have Space Cooties, or they would have had to bring a Scientologist to make him Clear.
Just a thought...it's an incomplete story. For all we know, the cause of death was determined to be something that could not be passed on-ex, stroke, heart attack, embolism, aneurysm, internal bleeding...
There are MANY diseases and conditions that mimic each other. AND...a person can have more than one thing wrong. It's quite possible that the rabies started triggering something else that this person had, which then caused the death. The rabies was present, but was not the factor that the medical profession saw. It's not exactly a common illness in North America.
Why do you/we have to guess at cause of death. Wouldn't the reporter check it out as it is basic to the entire story. You know: What happened?
I am an organ donor however,I do not want to ever have an organ transplant.The side effects of the anti-rejection medicine is just not worth it to me.
Well, yes and no. The anti-rejection meds have come a long way and folks are not suffering as much as in the past. I have two friends still alive after 7 years with transplants and they are very satisfied that a few pills daily keeps them here with family and friends, and loving life. Your choice, of course.
Shiboof,I learned something today.Thank you for that.I always thought that the medicines side effects were worse than the disease a person was suffering from.I am glad to know that you have two friends that are doing well after 7 years.I wish them many more healthful years.I would still rather be the donor.
Note that when something like this happens, it's places like Maryland and Minnesota (solved the salmonella source problem when Bush was POTUS) that solve it: states that spend money on competent agencies. Next time you complain about states with relatively high taxes, note that Maryland's shock trauma system is being copied by the U.S. army and it has the #1 rated school system in the country. You get what you pay for.
And then there's the blood transfusion. Most blood donors are actually blood merchants needing a little extra cash. Spend any time in a hospital and you will likely end up receiving a blood transfusion. Is blood checked for rabies?
"Rabies killed a patient who got a kidney transplant more than a year ago, federal officials said Friday"
This is the first line of this article when I read it. Please don't make fun, but I really don't understand this. The patient got a kidney transplant A YEAR AGO, and is only now dying, or is this something that they are just now reporting...I'm confused and probably missing something. Please explain. Thanks for staying nice :)
Good question.
From wikipedia: The rabies virus travels to the brain by following the peripheral nerves. The incubation period of the disease is usually a few months in humans, depending on the distance the virus must travel to reach the central nervous system.[2] Once the rabies virus reaches the central nervous system and symptoms begin to show, the infection is virtually untreatable and usually fatal within days.
I'm guessing that "usually a few months" can sometimes be longer.
Thanks MPA! I thought I was reading something into that that wasn't there...I guess I just always thought rabies happened quicker than that...
Terrible dilemma! Miss out on an organ because the rabies test takes too long or die from the disease after receiving a timely but infected organ. Awful stuff.
Check your facts: rabies isn't transmitted by blood. It's in nervous system tissue and nerves. This means in the spinal fluid and the brain. That's why the bite of an animal is a risk factor, but skinning one isn't. If it was in the blood of animals thousands of hunters would be dying every year. Other things are less important, but please get medical facts right before you hit "publish."
Humans give Rabies a bad name.
This is some seriously bad luck. All the waiting and preparing for an organ donation, and you get rabies?!? This poor patient. RIP
Did it occur to anybody that maybe it's not such a great idea to harvest organs for transplant from someone who died of an unknown disease? They leave it up to the surgeon to decide, but the surgeon is getting a whole lot of money for the transplant and no money at all for turning it down, so what's he going to do? Greed trumps prudence every time.
nonsense.
Here is the real take-away from this article: Change the default organ-donor status from "opt-in" to "opt-out". The result, well established in experience in other countries and psychological research, is that there will be many-many more organs available. This will allow thousands of lives to be saved, and it will allow us to pass over organs where there may be doubt. This might not have avoided this case, but the overall effect would be a massive savings of lives.
Ethically very questionable, given both the profits made in the transplant industry and the biases in distribution of organs. It's appalling to me that common people who have used medical marijuana to get through chemo are told that that makes them ineligible even to be considered for a new liver, while on the other hand wealthy and famous men who need a liver always seem to get one amazingly fast. Likewise, I think there ought to be far more weight put on the likelihood that the recipient will get more than a few years of functional life out of a transplant. I wouldn't get a transplant myself, and wouldn't want my body parts being parceled out by the people responsible for the current criteria.
Probable transmission of Toxoplasma gondii by organ transplantation was reported in the Annals of Internal Medicine Jan 1, 1979, by Ryning, Mcleod, Maddox, and Remington. That's 34 years ago. 'Unusual' infections have been known a long time, and are not that unusual.
Someone dies of an unknown illness and they still harvest the organs? I'm just waiting to see some tea partier blame this on Obamacare. Feel really bad for the parient but it seems there is something wrong with the transplant system if they will accept organs this way.
yes. If you make sure you nail down a definitive diagnosis, or else do not transplant the organs, you will be sacrificing the lives of many potential recipients from organs that are perfectly safe. On the other hand, if you do as they did in this case, you may run into problems as they have
But you don't get something for nothing
I wouldn't want an organ from a formerly normal person who had died of undiagnosed encephalitis-like symptoms. Most people who are on the transplant list are not imminently dying. If they'd die in a year or two without the transplant, but whatever killed the donor only took two or three weeks, then they could die a lot faster and harder if they get the transplant. I guess the question is, when a formerly healthy young person suddenly gets sick and dies, with neurological symptoms, and they can't find anything in lab tests or CAT scans to explain those symptoms (e.g., metabolic problems, a tumor), what is the likelihood that he had some sort of brain infection? 1%? 10%? 50%? And how high is too high to permit transplanting his organs without the recipient's informed consent?
You might if your life depended on it
depends on the organ. Heart and liver patients are EXTREMELY sick
2 years for many liver patients is wishful thinking.
i asked an infectious disease friend of mine that very question this weekend. She said very high
And how high is too high to permit transplanting his organs without the recipient's informed consent?
a) Just because there was an infection, it doesn't necessarily mean it is transmissable through the organ
b)who says there was no informed consent? You mean about the condition of the organ? Often if its not the best match the patient has the option of passing
I am amazed at the excuses people are making for such unprofessionalism! Talk about lowering standards?