TWO patients were critically ill last night after contracting rabies through infected donor organs. They are believed to have contracted the disease after receiving kidneys and a pancreas from a donor who died from a heart attack caused by a cocaine and Ecstasy overdose.
The organ donor, who had returned from India shortly before her fatal overdose, carried a donor card giving doctors permission to harvest her lungs, kidneys, pancreas, liver and cornea after her death.
A third patient was described as seriously ill but stable after a lung transplant. Another three patients benefited from the woman’s organs but have not shown symptoms of rabies. The patient who received the woman’s corneas has had them replaced as a preventive measure.
More than 60 doctors and nurses who came into contact with the dead woman and the transplant beneficiaries have been inoculated and are under observation.
The case is likely to trigger a review of the screening process for organ transplants.
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Rabies is one of the most terrifying diseases. As the infection advances, feverish patients scream, flail around and foam at the mouth. Doctors fear that the patients with the most serious infection, whose names have been withheld but one of whom is said to be over 70, are unlikely to survive. “There is almost no hope for them,” said Dr Manfred Thelen, head of the Johannes Gutenberg University clinic in Mianz, which handled the donated organs.
Professor Günter Kirste, of the German Donor Foundation, said: “Such a case has never happened in Germany before. Unfortunately it is not medically possible to exclude the chance of rare infection in advance, despite comprehensive examination of the donor. There will always be a residual risk in every transplant.”
In Germany, organ donors are screened for diseases including hepatitis B and C, HIV and syphilis, but testing for rabies is thought to take too long to be effective. Testing takes place in the short period — usually about six hours — between the donor being pronounced brain dead and the time that the organs are removed.
The infected organs were taken from a 26-year-old woman who died in December and distributed across the country to waiting patients with the appropriate blood group.
An investigation was begun yesterday into the woman’s movements in the months before she died. Relatives say that she was in India in October; about 30,000 people die there from rabies each year. It can take months for symptoms of rabies to show and the first signs — fever and headaches — are ambiguous. The woman showed no sign of the disease when she was admitted to hospital.
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It is the first documented case of rabies-blighted trans- plants in Europe, but there was a similar crisis in the US last summer.
The lungs, kidneys and liver of an Arkansas man were donated to four patients in Texas, Oklahoma and Alabama. Three of them died of rabies, the fourth of complications that arose during surgery.
As in Germany, the donor had shown no symptoms of rabies before his death from a brain haemorrhage. The Arkansas case was the first known incident in the world of rabies being spread through donated organs.
Blood donation practices have been tightened after the discovery that the West Nile virus — carried by mosquitoes — could be spread through blood transfusions and organ transplants.
Blood donations in the United States are automatically screened for the virus. The question yesterday was how far one could go to reduce the chances of an organ donor passing on rabies picked up from a high-risk zone.
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“One sensible precaution would be to impose tighter controls on organs donated from Eastern Europe and the Indian sub-continent where rabies is still a problem,” a senior doctor said.
Organ transplantation is highly sensitive because it is dependent on the unpredictable flow of donated organs. The demand is great but the supply is limited. “It is difficult to see what checks could have prevented the tragedy of a rabies-infected organ,” a spokesman for the German Donor Foundation said. “It was a regrettable exception.”
According to the Robert Koch Institute, there have been only two cases of rabies in human beings in Germany in the past ten years. Both patients had been abroad — one to India, the other to Sri Lanka. They both died.