A charred corpse was a memorial to a tragic mixup that ruined a kidney transplant. The recipient, unfortunately, died after developing rabies due to transmission from an infected donor. Public health officials in the country are closely monitoring this case. It sheds light on the uncommon but serious potential route for rabies transmission through organ donation.
Just about five weeks after the transplant, the kidney recipient started to feel the impact of a life-or-death mistake. These symptoms began with tremors, lower extremity weakness, confusion, and urinary incontinence. Two days after the onset of these symptoms, the patient was discovered unresponsive at home after a presumed out-of-hospital cardiac arrest.
“Overall, the risk is exceptionally small,” stated Dr. Lara Danziger-Isakov, highlighting the rarity of such occurrences. Investigators linked the rabies disease to the tissue donor. His generosity came just days after he had been scratched by a skunk and had to get rabies shots. Her case led to an extensive investigation that determined a “likely three-step transmission chain” in which a bat infected the skunk, which then infected the organ transplant donor. If so, this facilitated the transmission of the virus via the kidney and into the recipient.
According to the kidneys recipient’s family, the story is even more shocking. A skunk came up to them, showing predatory aggression to a kitten that the recipient was carrying. This interaction with the animal raised concern for rabies exposure. Even the hospital staff members who treated the donor initially dismissed the skunk scratch. They explained away his pre-admission signs and symptoms as worsening chronic co-morbidities.
After her symptoms started, the kidney recipient experienced extreme neurological issues. These side effects ranged from extreme confusion, difficulty with swallowing and walking, hallucinations, and a rigid neck. Although the patient was resuscitated and hospitalized, the patient never regained consciousness and was declared brain dead a few days later.
In another disturbing dimension of this case, three people received cornea grafts from the same donor. In order to avoid infection, they were immediately put on Post-Exposure Prophylaxis (PEP). Fortunately, those cases turned out to be asymptomatic, underscoring that timely action can reduce the threats posed by even these rare but serious transmissions.
Rabies is most commonly spread by saliva from an infected animal, usually via bites. Its inclusion in routine donor pathogen testing is still complicated by this rarity in humans as well, in the US. As noted in a report from the CDC, rabies is “excluded from routine donor pathogen testing because of its rarity in humans in the United States and the complexity of diagnostic testing.”