Tragedy struck yet again at Baylor University Medical Center, Dallas, Texas when a recipient apparently contracted rabies after receiving a piece of artery necessary for the successful completion of a liver transplant. The liver came from a healthy donor, but the artery came from a rabies-infected donor whose organs were connected to the other three deaths.

The diseased organ donor, an apparently healthy male resident of Arkansas who did not know he had rabies, arrived at Christus, St. Michael Hospital in Texarkana, Texas, in early May 2004 with “Severe mental status changes” and a low-grade fever. Neurological imaging revealed a brain haemorrhage, and the man died 48 hours later. His family agreed to donate his organs. Although the organs were screened for a host of infectious agents, rabies, because it remains so rare in humans, was not part of that screen.

By end of the first week of June, three recipients of the donor’s organs –t wo who each received a kidney and another who received the man’s liver-had died from rabies. Doctors assured the public that the deaths linked to the rabies-infected organs would be held to three, but the fourth case was identified by investigators at the U.S. Center for Disease Control and Prevention (CDC). Even though this case was operated on at about the same time as the other three patients and dies from rabies around the same time (June 7 or 8, 2004), the link came up only later.

As one of the doctors described it, transplant surgeons typically harvest major arteries along with organs, because they may be of use as well in recipients whose arteries are weak or compromised. Arteries in this case were sent to a special refrigerated “Vessel bank,” where they were labelled with the name of the donor.  The victim in this latest case required an artery because the vessels that came with the untainted donor organ he received were deemed “of poor quality”.

Asked why a link was not made earlier between the harvested vessel and the fourth patient, the doctors said that it was only when they got the word about the fourth case (from the CDC) that they came up with theories as to how it occurred. Despite labelling the vessels for storage, Baylor has no master file or database that would subsequently be entered into.

It is not clear whether these deaths will trigger a change in donor-screening policies. Test for rabies - a disease that remains rare in the U.S Population - take up to 24 hours to return results, the doctors pointed out, while transplants are of necessity often carried out within a few hours of the donor’s death.