FTA: “only four donors have transmitted rabies to recipients since 1979”

ONLY?! Rabies cases are really uncommon! I’m seeing 17 in the us from 2015-2024. Even assume double or triple the rates in earlier decades and, what, maybe 200 since 1978? 2-4% chance a given person who dies of rabies has their organs given to someone else? That’s an order of magnitude higher than I’d have guessed. WTF.

I question whether the original death here would have been tracked as rabies Vs heart attack.

Which also suggests perhaps it is slightly more common than data suggests

From the CDC report [1], it's pretty clear that rabies was not considered for the donor until after the donee died and rabies was confirmed. Possibly because the donor had been scratched by a skunk and not biten. The report says the scratch had been noted on the donor risk assessment interview (DRAI), but that skunks are not considered a reservoir for rabies in his area.

[1] https://www.cdc.gov/mmwr/volumes/74/wr/mm7439a1.htm

Skunks also aren't aggressive...

I thought rabies had to be considered for any interaction with a wild animal. For one showing atypical behavior, the indication is that much stronger.

Theoretically, the donor could die before the rabies infection developed into a disease. For example, in a car crash. IDK if this was ever the case. The incubation period is definitely long enough for this to be a plausible scenario.

Going by wikipedia, the incubation period can be up to three months. That isn't a particularly significant span of time if we're measuring how likely someone is to suffer an unexpected death. It's long enough that the possibility exists, but that's about all you can say.

Assuming an even distribution of deaths: 3 months / 80 years = 0.3% But there is very little people that is incubating rabies.

But the question isn't "what are the odds someone who dies in this period has rabies" it's "what are the odds someone who died after being infected with rabies died before they started showing symptoms" so the rarity of people incubating rabies is irrelevant.

Further, rabies incubation is highly variable - symptoms may not appear for years.

nit: surely the bounds for an acceptable organ is < 80 years old and > 15? maybe the window is closer to 50 years?

Ironically, if you feed the symptoms of the donor into an AI and ask for differential diagnoses, it will tell you: "Is there any history of animal contact? In that case, consider rabies."

My brain automatically went to Scrubs Season 5 Episode 20.

Mine replayed a couple of seasons of House, where this would be a staple in most episodes :)

I got a dermal graft in my hip. Unlike kidneys this is not really a live donation. The grafts are radiated to remove all DNA, so only the structure remains. The purpose of the transplant is to bridge torn tissue, and make the building blocks available to your body to rebuild the bridge (as I've been told).

I hope that radiation killed all (if any) viruses...

Was the kidney donor already dead, from something other than rabies, or were still alive for donation and later died?

> Was the kidney donor already dead, from something other than rabies, or were still alive for donation and later died?

FTA

> About five weeks later, the man started to hallucinate, have trouble walking and swallowing, and had a stiff neck, according to the C.D.C. report.

> Two days after his symptoms started, he collapsed of what was presumed to be a heart attack, the report said. The man was unresponsive and taken to a hospital, where he died.

> Several of his organs were donated, including his left kidney.

Seems like there is some part missing in evaluation procedure. If those symptoms were know at time I don't think he was eligible donator material anymore. Or at least to me it sounds like you want to know what was the cause behind those symptoms before harvesting anything.

Can't ask an unresponsive patient who then proceeds to die what his symptoms were ...

People seem to think that the TV doctor habits of testing the most out-there diagnoses possible until you get a positive hit are normal in the real world. They're not. Especially not with medical insurer's "advice" now being required for everything.

I thought only organs of people dying in accidents are donated, and not someone's dying from an illness.

I think the criteria for donation are most easily met by people who die as a result of something like a vehicle collision, but an otherwise healthy person who experiences sudden heart failure may have viable organs... From the reporting, this donor was not otherwise healthy, but maybe the symptoms were not known at the time or dismissed for some reason.

Not really. Organs from people who have died are almost always nonviable. So when it comes to vehicle collision victims, only people who are slowly dieing of internal hemorrhaging are used. Sudden heart failure organs are bad for two reasons: first, if the heart actually fails, you have minutes before organs are nonviable. Second, the medication that's used for trying to keep the heart beating will actually accelerate death, including organ death, if it doesn't work.

Most organs come from from people, usually braindead, who are definitely going to die, but you have days or at least hours before the body actually loses the fight. And even then the extraction process needs to be started quickly, because in the process of dieing the body will, as it's losing blood, ie. power and oxygen, one-by-one cut off blood flow from organs to try to keep the heart, lungs and brain alive. Most organs that have had their blood flow cut off by the body can't be transplanted, so extraction needs to happen before that point.

So that was probably the case here.

(wait until you figure out the answer to the other question ... "wait, if organs after death are not used, nonviable, then what happens if I donate my body to science" ?)

Don't have access to NYTimes, but do they mention anything about all the other people that received an organ? I'm assuming they are tracking them down to get them rabies vaccine?

The donor's corneas were used for grafts for three others. The article states:

> The three patients’ grafts were removed, and one tested positive for rabies, the doctors said. None of the three patients had symptoms of rabies, but they were being treated with preventive drugs, the report said.¶ Since 1978, four organ donors have passed rabies to 13 organ recipients, the report said. Of the 13 recipients, six who received treatment for rabies survived. The seven others, who did not receive treatment, died.

Four of those seven were in an incident from May 2004, which you can read about here: <https://www.nejm.org/doi/full/10.1056/NEJMoa043018>

> We're gonna need that cornea back.

Not exactly a sentence you would hope to hear...

The donor died from rabies, and then several of his organs were donated. Furthermore: "Doctors reviewed records about the kidney donor and learned that the Idaho man’s family had disclosed the skunk scratch to doctors when his organs were being donated, the report said."

The first half of the first sentence of the article:

> A man died of rabies after getting a kidney transplant from another man who died of the virus

That sentence doesn't indicate the sequence of events. Both of the following sequences match the sentence; thus the confusion.

Sequence 1:

Day 0) Donor contributes kidney to donee

Day 10) Donor dies of rabies

Day 15) Donee dies of rabies

Sequence 2 (the incident sequence)

Day 0) Donor shows symptoms of rabies (undiagnosed)

Day 2) Donor dies of rabies (diagnosed as heart failure)

Day 2+?) Donor's kidney is installed in donee

Day N) Donee dies from rabies

Day N+M) Donor's death is reevaluted and rabies is diagnosed

Yeah I phrases that wrong, I'm wondering if the donor was alive or if they harvested organs from somebody that was dead from rabies.

They harvested organs from somebody who had died of rabies.

If you've seen Scrubs...