Infected organs pose deadly transplant risk

Posted on Jun 19, 2010 in Health & Wellness

Victims contract West Nile, rabies, parasites – and a rare hamster virus

George Boucher endured more than three years of dialysis waiting for a new kidney, even turning down one organ on his doctor’s advice because it came from a high-risk donor, his wife said.

But in May 2005, less than a month after the 54-year-old Rhode Island man received the long-awaited organ, Boucher was dead, felled by a rare infection that lurked undetected in the transplanted kidney.

The source? A pet hamster bought the month before the organ donor’s sudden death.

Story continues below ↓advertisement | your ad here

It was a diseased rodent whose virus, lymphocytic choriomeningitis — known as LCMV — was transmitted from the donor to four people who received her organs, killing three of them. The fourth became critically ill, but survived.

Last month, that victim and the families of the others settled a two-year lawsuit against the retailer PetSmart, who they claimed failed to screen the sick hamster or to warn pet owners about potential dangers.

But Boucher’s widow, Helen Boucher, 60, of Pawtucket, R.I., said the confidential financial settlement does little to resolve a more vexing question: How can transplant recipients be certain the organs they get are safe?

“It’s just mind-boggling,” said Boucher, a loan-servicing manager. “We only heard good things about transplants.”

Certainly, receiving an organ infected with a hamster virus is a rare thing. So is a man contracting uterine cancer from a woman’s diseased kidney, as in the recent high-profile case of Vincent Liew.

In Liew’s case, the donor’s disease was discovered after the transplant, but doctors didn’t think the uterine cancer could spread to the 37-year-old Queens man. His widow lost a bid last month for more than $3 million in damages when a jury ruled in favor of the hospital that performed the transplant and follow-up care.

Though unusual and shocking, such cases are examples of a small but growing number of diseases passed on through donor organs, including bacterial infections, viruses such as West Nile, rabies, tuberculosis, parasites and several kinds of cancer.

Prime for infections

Organ recipients are unusually likely to develop life-threatening illnesses from such infections because the transplant drugs they take suppress their immune systems dramatically.

No question, most transplants are safe — and necessary. More than 28,000 are performed in the U.S. each year, but 108,000 people need the operations and more than 6,500 die waiting.

As demand for transplants grows, however, concern about safety is rising, too. Many transplant experts are calling for better screening and tracking of donors, even as others worry that extra steps will slow down transplants and risk wasting urgently needed organs.

No one knows how many diseases are transmitted through infected organs, said Dr. Matthew Kuehnert, director of the Office of Blood, Organ and Other Tissue Safety at the federal Centers for Disease Control and Prevention. The U.S. does not have a national surveillance system in place to monitor disease transmission after donation, and a landmark report last fall suggested that the nation’s periodic monitoring is patchy at best.

The United Network for Organ Sharing, which oversees transplants, began requiring reports of disease transmission in 2004. Since then, they’ve been steadily rising, from seven reports of diseases from donors in 2005 to 152 reports in 2009.

Overall, that suggests that about 1 percent of organs from deceased donors may transmit infections, but that number is likely an underestimate, Kuehnert said.

“Because of the dire need for organs, emphasis has been on monitoring transplant availability, and not on unintentional disease transmission,” he said.

But Dr. Michael G. Ison, who heads a UNOS advisory committee on transplants, said many infections transmitted by organs are known and expected and can be treated successfully in the recipient.

The rising numbers actually represent greater awareness of and attention to the issue, said Ison, a transplant infection expert at Northwestern University’s Feinberg School of Medicine in Chicago.

All donated organs are required to be screened for a battery of infections, including HIV, hepatitis and syphilis, as well as rare diseases such as the HTLV virus, which can cause leukemia, the cytomegalovirus, or CMV, and the virus that can cause Epstein-Barr syndrome.

But because organ donation is usually conducted in a crisis, where time is crucial, infections sometimes are present in organs that test negative initially. Screening practices can vary by institutions because they can be expensive and incomplete. And some infections can’t be screened at all.

That was the case with Boucher and the others who got the organs infected with the hamster virus. There is not an approved screening test for LCMV, and even when the tests are conducted, they’re not sensitive enough to be routinely reliable.

Courtesy of John Platt

Peter C. Platt, seen with his wife Shirin, died last year after receiving a kidney infected with an intestinal parasite.

No one even thought to test for the intestinal parasite that infected the kidney received last year by Peter C. Platt, a 68-year-old New Jersey leasing industry executive who had to be hospitalized within weeks of his March transplant. Doctors couldn’t control the infection that ensued and Platt died on July 15. A CDC investigation revealed that he was infected with strongyloides, an intestinal parasite common in sub-tropical countries. His donor, a middle-aged woman who lived in Las Vegas, was originally from Honduras, where the parasite is endemic.

“Wrong is the word I come up with often,” said his widow, Shirin Platt, 67, of Freehold, N.J., who has pressed health officials to provide better information about transplantation risks. “It was so wrong.”

All transplant recipients are warned of risks, said Ison, the infection expert. And, often, in cases of very rare infections, the situation is tragic but unavoidable.

“Most of the time, I don’t think there’s anything that could be done differently,” he said. “No matter what, there’s no way we would be able to prevent every disease transmission.”

To put the issue in context, many of those who need organs will die without them, Ison said.