Thu Jul 1, 2004

Rabies via Organ Transplant

The Centers for Disease Control report that three people have died from rabies contracted after receiving transplants that originated with the same donor. The donors lungs, liver and kidneys were recovered. The lung recipient died during the transplant of unrelated causes. The recipients of both kidneys and the liver died of rabies. In their more detailed investigation of the events, the CDC report that the donor

as an Arkansas man who visited two hospitals in Texas with severe mental status changes and a low-grade fever. Neurologic imaging indicated findings consistent with a subarachnoid hemorrhage, which expanded rapidly in the 48 hours after admission, leading to cerebral herniation and death.

Rabies has about a three-week incubation period, and the three surviving recipients were re-admitted to hospital between 21 and 27 days after their transplants, where they died. Regular readers of CT know that one of my main research interests has been the social organization of exchange in human blood and organs. In particular, I’ve looked at how the logistical underpinnings of the procurement system drive variation in rates of donation, and argued that it’s a mistake to frame the debate about organ donation in terms of stylized images of givers versus sellers. In other words, whether the process is industrialized matters more than whether it is commodified. Often, it’s only in tragic cases like this that this logistical aspect is brought to light. Of course, that doesn’t mean I think highly rationalized organizational systems are a necessarily a bad thing. Just take the CDC itself, and its remarkable Morbidity and Mortality Weekly Report, which tracks what people are dying from this week in the United States. The MMWR was where the earliest signs of the size of the HIV disaster became apparent to the epidemiologists, though alas not to the blood banks or the Reagan administration.