A routine kidney transplant took a tragic turn when a Michigan resident died as a result of contracting rabies from the donated organ. This event spotlights an extremely rare but devastating risk of organ transplantation and the importance of timely treatment following potential rabies exposure.
The patient received the transplant at the University of Toledo Medical Center. As reported by the Toledo Blade, UT spokesperson Tyrel Linkhorn said, “Person-to-person transmission of rabies is extremely rare, though it has been documented in a very small number of cases involving organ transplantation.” He also noted that a thorough investigation affirmed that all best practices and safety standards were properly upheld. The Michigan Department of Health and Human Services also reported that all healthcare providers and anyone else exposed to the transplant patient were evaluated for rabies exposure and given post-exposure prophylaxis if needed.
The Stealthy Virus
Rabies is a viral disease that affects mammals. It is carried in saliva and spread through bites from infected animals. The virus infects the central nervous system, causing severe brain inflammation and symptoms like aggression, confusion and fear of water. After symptoms emerge, rabies is nearly always fatal. However, prompt testing following an animal bite and administration of post-exposure prophylaxis, consisting of the rabies vaccine and antibodies, can effectively prevent death if given before symptoms arise.
Thanks to widespread pet vaccinations and animal control efforts, rabies deaths among people in the US have decreased dramatically since the 1960s. There are now fewer than 10 rabies-related deaths annually, mostly from encounters with wildlife such as bats, raccoons, skunks and foxes.
Tracing the Source
In the recent case, the organ donor had unknowingly contracted rabies after encountering wildlife in Idaho five weeks before death and organ donation. Notably, the donor did not exhibit any traditional rabies symptoms after exposure, so they did not seek medical attention, resulting in the virus remaining undetected until after transplantation.
Current protocols include screening organs before transplantation but typically exclude testing for rabies unless explicitly suspected. This is largely due to time constraints, as the viability window for organs is mere hours and rabies tests typically take days.
Lessons From the Past
Transplant-related rabies cases are rare but have occurred before. In 2004, rabies transmission was implicated in four deaths of transplant patients who had received organs from a common donor. In 2013, a Maryland resident’s death was linked to an organ transplant that had occurred more than a year before. In the 2013 case, other people who had received organs from the same donor were given post-exposure prophylaxis.
In response to the recent incident, the CDC swiftly intervened, halting the transplant of a corneal graft from the same donor intended for a Missouri resident. Three other corneal graft recipients from that donor received immediate prophylactic treatment.
Ensuring Continued Trust
Health officials stress that despite this tragic case, transplant procedures remain incredibly safe and they are governed by stringent protocols. Daniel Kaul, a clinical professor at the University of Michigan’s Infectious Disease Clinic, underscored the fact that organ transplants save thousands of lives annually, with benefits far outweighing the risk of such extraordinary events. “The risk of not getting a transplant if you have organ failure is so much higher than this kind of incredibly rare but tragic situation,” he said.
Moving Forward With Vigilance
Rabies surveillance is critical to controlling the disease and preventing its spread to humans. While cases of transmission via organ donation are rare, lifesaving transplants continue to be safe, trusted procedures.
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