News has just been released by the CDC (Centers for Disease Control and Prevention) CDC rabies story of the third known episode of human to human rabies transmission through organ transplantation. Thankfully this is extremely rare, though lethal. All that has been shared thus far is that one of 4 organ recipients from the same organ donor in 2011, died more than one year later of the same raccoon type of rabies as the donor. To be clear, the donor was NOT known to have rabies at the time of death – this is the essence of the problem.
A key principle in deceased organ donation is that the cause of death must be known – in order to prevent exactly this type of disease transmission. If there was a rapid test for rabies that could be applied, then we could exclude it. But there is not, so we must rely on having another cause of death. In the first episode of transmission in 2004, cerebral hemorrhage in the donor was a plausible cause of death and the simultaneous presence of rabies was a complete surprise. The devastating result was the death of all 3 recipients from transmitted rabies.
With today’s news we have also learned that 3 of 4 recipients remain alive and are being treated aggressively with immunoglobulin (passive therapy) and anti-rabies vaccination (active therapy). Let us all hope that they survive this tragedy. We accept the cryptic nature of the information being released – clearly the patients and donor are all entitled to privacy. We await more information so that we may sharpen our questions and choices with respect to acceptance of potential organ donors. But please remember that the severity of the current organ shortage that is associated with the deaths of 16-18 persons per day in the U.S. makes it very difficult for us to turn down donors who seem to be appropriate. What we must be certain to do is to appropriately educate and involve potential recipients about known risks such that their choice may also be informed.