A Maryland man who had received a kidney transplant one and a half years ago from a Florida donor who died in February, 2011, died on February 27, 2013 at the VA Medical Center in Washington after he became ill. Because rabies was suspected to be the cause of his death, a sample of his brain was sent to the CDC for testing, which confirmed the diagnosis this month. After the rabies diagnosis, a sample of the donor’s brain that had been saved was also tested and resulted in the diagnosis that the donor had been infected with raccoon-type rabies (the same type of rabies that caused the Maryland man’s death).
The donor had a change in his mental status before he died and the doctors in the Florida hospital knew that the donor had encephalitis (inflammation of the brain) when the donor’s organs were harvested for transplantation but did not know that the donor had rabies at that time. The other three recipients of the donor’s organs (a kidney, heart, and liver) have been contacted and have not shown signs of rabies. They are nonetheless being treated with five doses of the rabies vaccine and rabies immune globulin by injections into the upper arm to protect against the rabies virus.
Rabies infections in the United States are exceedingly rare, with only one to three cases nationwide on a yearly basis. Donor organs are not routinely tested for the rabies virus because rabies is so rare and because only three or four facilities in the United States have the capability to test for rabies. Because it could take two days to get back testing results for rabies, the delay would cause the donated organs to be no longer viable for transplantation and the potential organ recipients may loose their only hope for a cure or a better quality of life.
Rabies acquired from a donor organ is exceedingly rare in the United States. The last reported cases were in 2004 when the organs and tissues from a donor who had been infected with the rabies virus caused the deaths of four recipients within a month of receiving the donated organs/tissues. The donor in the 2004 rabies incidents was not known to be infected with the rabies virus at the time of the donor’s death.
What Is Rabies?
According to the CDC, rabies is a preventable viral disease of mammals most often transmitted through the bite of a rabid animal. The vast majority of rabies cases reported to the CDC each year occur in wild animals like raccoons, skunks, bats, and foxes. More than 90% of all animal cases reported annually to the CDC occur in wildlife; before 1960 the majority were in domestic animals. The principal rabies hosts today are wild carnivores and bats.
The rabies virus infects the central nervous system, ultimately causing disease in the brain and death. The early symptoms of rabies in people are similar to that of many other illnesses, including fever, headache, and general weakness or discomfort. As the disease progresses, more specific symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hypersalivation (increase in saliva), difficulty swallowing, and hydrophobia (fear of water). Death usually occurs within days of the onset of these symptoms.
The annual rate of rabies deaths in humans in the United States has declined from more than 100 at the turn of the century to one or two per year in the 1990’s. Modern day prophylaxis has proven nearly 100% successful. Human fatalities due to rabies in the United States occur in people who fail to seek medical assistance, usually because they were unaware of their exposure.
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