WASHINGTON — Maryland health officials are recommending enhanced screening of potential organ donors in response to a rare case in which a patient died of rabies after receiving a kidney from an infected donor.
The patient, an unidentified Army veteran from Maryland, died in February, about a year and a half after receiving the kidney. The donor, 20-year-old William Edward Small, as an avid outdoorsman from North Carolina who got sick after a fishing trip in Florida, where he was undergoing Air Force training. Doctors thought Small had died from eating tainted fish.
The recommendations in a report on the case from the Maryland Department Health and Mental Hygiene are similar to those made by the federal Centers for Disease Control and the United Network for Organ Sharing, which last year issued guidance to help organ procurement organizations screen for encephalitis and other central nervous system infections in potential donors.
The case attracted public attention because of the rare circumstances. It was just the third documented transmission of rabies through a solid organ transplant, and it was Maryland’s first fatality from rabies since 1976.
The Maryland report was completed this week and provided to The Associated Press. It noted that because decisions to transplant organs must be made quickly, “it is not possible to wait for test results prior to transplantation. The organ transplantation community should consider enhancements to both the screening process when organ donation is being considered and testing protocols and notification of results so that recipients can be managed in a timely fashion with all possible medical data available.”
Nine months after the transplant, the United Network for Organ Sharing issued guidelines urging caution in accepting organs from donors with encephalitis, a brain inflammation that is one symptom of rabies. In response to the patient death, a report from the CDC said a uniform donor questionnaire could help better identify risk factors for the virus and that rabies should be considered in donors with unexplained encephalitis.
The Maryland report also detailed the state’s response after the rabies diagnosis. It said 327 people — including medical workers and relatives and friends of the victim — were assessed for exposure to rabies. Of those, 19 received a prophylactic rabies vaccine.
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