Here's a case that will have the risk management folks debating for a while. A man in Maryland recently died from rabies. It turns out that the cause may have been rabies from the donor of his new kidney. Lots of screening is done before kidneys are transplanted, but not for this disease. Should there be, or is it just too rare? Here are some excerpt from the Washington Post story:
A Maryland man who two weeks ago became the state’s first fatal case of rabies in nearly 40 years contracted the infection from a kidney transplant, according to two people familiar with the case.
The Centers for Disease Control and Prevention compared rabies virus obtained from the recipient and determined that it was genetically identical to the virus recovered from the organ’s donor, said the two people involved in the case.
In general, fewer than five cases of rabies are diagnosed each year in the United States. Most often the virus is acquired by contact with a bat. Bites from infected raccoons and dogs, or contact with their saliva, account for most of the rest.
Transmission of rabies through organ or tissue transplant is extremely rare. Four people in Texas died in 2004 from rabies contracted from a single donor’s tissue. There have been at least eight cases around the world contracted through cornea transplants.
Potential organ donors are screened for a standard battery of infectious diseases before their organs are offered. Rabies is not one of them, however.
“You balance the probability of infectious complications with the cost of not undergoing the transplant,” said Dorry Segev, a transplant surgeon and epidemiologist at Johns Hopkins University who had no involvement in the case. “The risk of death on dialysis is anywhere between 5 to 15 percent per year, and sometimes higher.”
Segev said that transplanting an organ from someone who died of an infection whose cause was not known would be “incredibly rare” but that it occasionally happens.
I wonder if it would be practical to conduct rabies tests on organ donors. Look at whatthe CDC says Several tests are necessary to diagnose rabies ante-mortem (before death) in humans; no single test is sufficient. Tests are performed on samples of saliva, serum, spinal fluid, and skin biopsies of hair follicles at the nape of the neck. Saliva can be tested by virus isolation or reverse transcription followed by polymerase chain reaction (RT-PCR). Serum and spinal fluid are tested for antibodies to rabies virus. Skin biopsy specimens are examined for rabies antigen in the cutaneous nerves at the base of hair follicles.