A Georgian who got an organ transplant in 2011 now must take drugs to prevent rabies — a case so rare that only one other has ever been recorded in the United States.
Doctors began the treatments after a Maryland man who received a kidney from the same donor died two weeks ago of what the Centers for Disease Control later determined was rabies. Two other people who received organs from the same donor are also being treated. One lives in Florida, the other in Illinois.
None of the three living recipients has contracted rabies; all are doing well. Authorities have not identified them due to privacy considerations.
The only similar instance in the United States took place in Texas in 2004, when three patients died as a result of organs transplanted from an infected donor.
The present case is especially peculiar in that the transplants, of organs donated by a Florida resident, took place more than a year ago. The donor died of encephalitis, a swelling of the brain; doctors were unable at the time to determine a cause.
Just before the Maryland patient died earlier this month, doctors treating him came to suspect rabies. CDC officials eventually confirmed that diagnosis and traced the source by sampling tissues from the organ donor.
Only a handful Americans are diagnosed with rabies each year after coming in contact with infected animals. Health officials stressed Friday that the risk of rabies being transmitted via an organ transplant is so minuscule that patients needn’t worry.
“I think if people are concerned, they should talk with their transplant doctor,” said Dr. Matthew Kuehnert, the CDC’s director of the Office of Blood, Organ and Other Tissue Safety. “But we think this is a very, very rare event.”
Donated organs aren’t screened for rabies, he said, because the most accurate tests take longer than a typical organ’s six-hour shelf life.
“It’s very important to understand that balance between safety and availability,” he said. “(People) are waiting on the transplant list, and if they don’t receive an organ, they could die.”
Steve Tanner, of Ball Ground, received a liver in late 2010 after a long illness. He said that even though he didn’t know at the time that rabies was a potential risk, it wouldn’t have mattered.
“For me, I was so sick that I would’ve taken the chance anyway,” said Tanner, 39 . “You’re already battling enough as it is. You’re dealing with the fact that you are near the end of your life and that somebody gave their life for you.”
While he’s saddened for the families mourning the deaths of the Maryland man and his donor, Tanner pointed out that the donations served a crucial purpose.
“For the other people, they were saved that day,” he said.
More than 28,000 organ transplants were performed in the U.S. in 2012, according to the Organ Procurement and Transplantation Network. As of this week, around 117,000 Americans are on the organ waiting list.
Most transplant-transmitted infections become evident within the first six months of a surgery, Kuehnert said, though this case took more than a year.
Rabies cannot be detected in a person until a few days before symptoms appear, said Dr. Richard Franka, lead of the CDC’s rabies team. That further complicates any thought of testing either donors or recipients.
To help curb the risk, donor organizations often ask next-of-kin whether the donor may have been bitten by an animal, such as a dog or raccoon, or could otherwise have been exposed to rabies. Health professionals began asking family members about the rabies risk following the 2004 case.
It’s unknown how the Florida donor contracted the disease or whether the donor’s family was asked about any potential exposure to rabies.
Julia Roberts, of Atlanta, said both of her children have received kidneys within the past six years. Of all the things her family worried about in the time leading up to the donations, rabies was not one of them.
“From my point of view as a parent … the last thing on my mind would be a rare condition or disease that could be transplanted, because you only think about the biggies: AIDS, HIV, Hepatitis, any kind of bacterial thing,” she said.
She’s confident that her children, 14-year-old Gage and 11-year-old Quinnlin, aren’t carrying rabies. Both their donors are still alive, and living donors are screened for months before the surgery takes place.
Even if a recipient did learn that his or her donor had been exposed to rabies, she said, the news might come just one more hurdle to climb.
“You never really think you are scot-free,” she said. “When you get an organ you are exchanging one set of problems for a new set of problems … you still have a lot of other things to worry about.”
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