The donor, described as a man in his 20s, died of encephalitis, a general term for inflammation of the brain. The condition has many causes. Viruses such as herpes simplex and West Nile virus are among the more common. Rabies is among the rarest.
Details of the donor’s medical care could not be learned. In particular, it was not known what tests were done and which diagnoses were considered before he died. But rabies was not diagnosed until his brain, which had been preserved, was examined after the death of the recipient in Washington.
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Maryland officials said an adult resident has died of rabies, the first human case since 1976.
Trade of some species is banned; others such as U-Md.’s diamondback terrapin would fall under strict quota.
Potential organ donors are screened for a standard battery of infectious diseases before their organs are offered. Rabies is not one of them, however.
“The decision whether to accept or reject an organ is an independent medical judgment based on the testing and information the physicians have on the potential donor,” said Joel Newman, a spokesman for the United Network for Organ Sharing, the national organization in Richmond that helps coordinate transplants.
What screening tests were done on the donor and his tissue in addition to the usual ones also could not be learned. Blood tests usually reveal antibodies to the virus, and the infection is confirmed by examining thin slices of brain tissue under a microscope. Several experts said it is unlikely that rabies could be ruled out for certain within the time window in which a transplant has to be done.
“Everyone was taken aback that someone who dies of encephalitis is considered acceptable to donate an organ,” said one person involved in the case.
Organs from people with known infections are, however, occasionally transplanted. In some cases, the recipient already has the infection, such as hepatitis C. In other cases, the patient and physicians conclude that the risk of dying from the infection is less than the risk of dying while waiting for another organ.
“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.