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4th Death Tied to Rabid Organ Donor

News comes after assurances that tissues were accounted for

THURSDAY, July 8, 2004 (HealthDayNews) -- After assuring the public last week that all transplanted organs and tissues linked to three rabies deaths in organ recipients were accounted for, doctors at Baylor University Medical Center announced on Thursday a fourth death tied to the same rabies-infected donor.

The victim in this latest case, who officials described only as hailing from North Texas, 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 the rabies-infected donor whose organs were connected to the other three deaths.

In a heated press conference, Baylor doctors tried to explain why, after assuring the public last week that the deaths linked to the organ donor would be held to three, a fourth case was identified early Thursday by investigators at the U.S. Centers for Disease Control and Prevention.

According to officials at the Dallas hospital, the fourth victim underwent a liver transplant at or around the same time as the victims in the other three cases -- the beginning of May -- and died from rabies at approximately the same time as those three victims, around June 7 or 8.

"Would I have acted differently in terms of working these patients up? No, nothing. I think everything we did was appropriate, the standard of care for preventing what anyone would consider could cause infection or harm transplant patients," said Dr. William Sutker, chief of infectious diseases at Baylor. The two surgeons involved in the transplant, Dr. Edmund Sanchez and Dr. Henry Randall, were also in attendance at the conference.

According to Sutker, CDC pathologists alerted Baylor at 3:30 a.m. Thursday to the possibility of the fourth death link.

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, Tex., in early May with "severe mental status changes" and a low-grade fever. Neurological imaging revealed a brain hemorrhage, 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 the end of the first week of June, three recipients of the donor's organs -- two who each received a kidney and another who received the man's liver -- had died from rabies. Another organ recipient died on the operating table, and didn't have time to develop the disease.

The CDC immediately launched an extensive investigation into the matter.

In a press conference held July 1, Baylor doctors said that all organs and tissues had been accounted for, assuring the public that the death toll would stop at three. The CDC echoed that point Thursday, when it wrote in its publication Morbidity and Mortality Weekly Report that "no other organs or tissues were recovered from the donor."

This fourth case therefore raises serious questions.

As Sutker 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 labeled 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," Sutker explained.

Asked why a link was not made earlier between the harvested vessel and the fourth patient, Stutker told reporters, "We did not withhold any information. It's only when we got the word about the fourth case [from the CDC] that we came up with theories as to how it occurred."

Despite labeling the vessels for storage, Sutker said Baylor has "no master file. We have labels on the blood vessels, but there's no master file or database that would subsequently be entered into."

At Thursday's press conference, Baylor officials again assured the public that, at this point in time, all of the vessels and organs harvested from the rabies-infected donor have been destroyed, and there is no further danger to patients at Baylor or to the public at large.

Furthermore, Sutker said, everyone known to have come in contact with the donor or the four victims has been tested for rabies, with no other cases evident.

The Associated Press on Thursday identified the original donor as William Beed Jr., and the first three victims were identified as kidney recipient Cheri Jean Wells Biggs, 50, of Mesquite, Texas; liver recipient Jimmy Paul Martin, 52, of Oklahoma; and Joshua "Bubba" Hightower, 18, of Gilmer, Texas.

It's not clear whether these deaths will trigger a change in donor-screening policies. Tests 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.

More information

The U.S. Centers for Disease Control and Prevention has more on rabies.

SOURCES: July 8, 2004, news teleconference with William Sutker, M.D., chief of infectious disease, Baylor Medical Center, Dallas; Associated Press
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