Transplantation Associated Rabies

This week's JAMA has a paper and editorial on the recent case of transplantation associated rabies. I blogged about this a few months ago based on the report in the Washington Post. The editorial helps to put all of this in perspective by pointing out that transmission of disease from donor to recipients is a rare occurrence (0.1%) and that many patients die each year while awaiting transplantation. Both the paper and the article make recommendations on how to make the process safer, particularly with regards to how to handle donors with unexplained encephalitis. Even still, as the editorial points out, some donors with infectious encephalitis have had masking conditions (e.g., subarachnoid hemorrhage, intoxication with drugs of abuse, or head trauma). Neither paper mentions that there could be two sets of exclusion criteria for donors--those for when the organ is immediately life saving (primarily heart and liver), and those in which it is not (primarily kidney). Most patients and families would likely be willing to accept a higher level of risk when the transplant is immediately life saving. Fortunately in this case, the three other organ recipients from the rabies infected donor remain infection free.