The first Marylander to succumb to rabies since 1976 developed the virus through a kidney transplant that took place more than a year before the Army veteran died of the disease in February, national health and defense officials said Friday.
Tests performed by the U.S. Centers for Disease Control and Prevention since the Marylander's death showed that the Florida organ donor, a 20-year-old Air Force service member, died of rabies, and the same type of rabies was found in both the donor and the kidney recipient. The transplant occurred at the Walter Reed National Military Medical Center in Bethesda, confirmed Cynthia Smith, a Defense Department spokeswoman.
Contracting rabies from organ transplant is extraordinarily rare, but other deaths have been reported in the past. Officials and medical experts said it's probably impossible to determine whether a donor has rabies before transplanting an organ.
Both the CDC and Maryland health officials said they would not release any information regarding the genders of the donor or recipient, or the names of medical facilities involved with the case. CDC officials are working with public health officials and health care facilities to investigate how the donor contracted rabies.
The donor also gave another kidney, a heart and a liver to living recipients in Florida, Georgia and Illinois, said Barbara Reynolds, a CDC spokeswoman. She said the recipients have been evaluated by their health care teams and were being given the rabies vaccine and immune-system boosters.
Before an organ is transplanted, tests are performed to determine whether the donor has any transmissible diseases, said Joel Newman, a spokesman for the United Network for Organ Sharing, the private organization that manages the country's transplant system.
UNOS maintains a list of tests that must be run on all potential donors, including taking blood and urine samples and conducting a chest X-ray. Doctors and organ recovery teams can decide whether to run additional tests based on the information available to them from the donor's medical history, Newman said.
David Leeser, chief of kidney and pancreas transplantation at the University of Maryland Medical Center, said doctors are primarily looking for blood-borne diseases, such as HIV, hepatitis and syphilis.
In the recent case, Leeser said, four medical teams working with organ recipients must have examined the organs from the donor who had rabies, and all decided they were acceptable for patients.
There's a 24- to 48-hour period after a potential donor has died to harvest and transplant, but not all medical tests can be completed in that time, Newman and others said.
"There's not really a confirmatory rabies test that would turn a result in a 24-hour window," Newman said.
Charles Haile, chief of infectious diseases at Greater Baltimore Medical Center, said brain tissue or spinal fluid is often needed to determine whether someone has rabies.
The disease can be difficult to diagnose because it can present atypically, he said, without the classic symptoms of lethargy, restlessness, irritability or swelling of the brain. Also complicating a diagnosis is that some people can harbor rabies for more than a year without displaying any symptoms, even though the incubation period typically lasts several weeks to a month.
Haile called the chances of transmitting rabies through an organ transplant "infinitesimal."
Any transplant patient who accepts an organ is taking a risk, but there's no way to test for every possible disease within the tight time parameters, said Dorry Segev, transplant surgeon and epidemiologist at the John Hopkins University School of Medicine.
"The likelihood is we would be discarding perfectly good organs," he said.
Charlie Alexander, president and CEO of the Living Legacy Foundation, the organ recovery organization for the Baltimore region, said sometimes a potential recipient who is facing death will choose to take a donor organ even if the donor had a disease, but that it was highly unlikely a person would accept an organ if the donor were known to have rabies.
He also said that's not something that can be determined before an organ transplant. The only way to have prevented this rabies death, he said, would have been not to conduct a transplant.
"You're really dealing with the world of rare events," he said.
Maryland's health department announced the rabies death earlier this week, cautioning people around the state to take care around wildlife and to report any animal bite to health officials. Rabies cases have grown uncommon, with five or fewer reported nationally over the past decade, largely because of effective preventive treatments given after an animal bite occurs.
Rabies has been known to spread via organ transplant surgeries in the past. In 2004, the CDC confirmed diagnoses of rabies in three organ recipients who all received organs from a common donor. The donor was an Arkansas man who visited two Texas hospitals complaining of mental health problems and a low-grade fever, according to the CDC. His liver and kidneys were passed along to organ recipients, who each died.
The type of rabies both the organ donor and recipient had is known to come from raccoons but can also be found in other animals.
Baltimore Sun reporter Scott Dance contributed to this article.
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