Rabies Virus Hid in Organ Donor, Surfaced in Recipient

A Maryland man who died from rabies after receiving a kidney from an infected donor is the eighth known victim of rabies-tainted solid-organ transplants, according to a new report.

The man, whose name and age have not been released, developed brain inflammation known as encephalitis in February, 17 months after the transplant, according to the report published today in the Journal of the American Medical Association. He died 26 days later.

At the time of the transplant, the organ donor was brain dead from what doctors thought was ciguatera, a form of food poisoning caused by contaminated fish. That he had recently been bitten by two raccoons, the most frequently reported rabid animal in the United States, went unreported until after the transplant, according to the report.

"This transmission event provides an opportunity for enhancing rabies awareness and recognition and highlights the need for a modified approach to organ donor screening and recipient monitoring for infectious encephalitis," the authors wrote.

Read about how CDC scientists traced the kidney recipient's death to the tainted transplant.

The donor fell ill after a fishing trip, developing nausea and tingling in his arms, signs of both rabies and ciguatera. But brain scans taken before his death failed to find signs of encephalitis, the hallmark of rabies, leading doctors to determine there was "no increased risk for infectious disease transmission," according to the report.

His heart, liver and kidneys were transplanted into four people.

An autopsy independent of the organ procurement soon determined ciguatera to be "extremely unlikely" in the donor's death, which was ultimately blamed on "complications of severe gastroenteritis," according to the report.

A year and a half later, after the death of the kidney recipient, post-mortem testing of the kidney and brain tissue from the donor revealed the same strain of raccoon rabies. It's unclear whether the hospital or anyone involved in the transplant was reprimanded. The names have not been released.

Disease transmission from transplanted organs is rare, according to Dr. Michael Green, chairman of the Organ Procurement and Transplantation Network and United Network for Organ Sharing's Ad Hoc Disease Transmission Committee.

"That said, for any individual potential organ donor and potential organ recipient, the risk of a potential disease transmission must be weighed against the potential adverse outcomes associated with not getting a transplant," said Green, who is also a professor of surgery at the University of Pittsburgh School of Medicine.

"The organ procurement organizations have careful screening procedures, and the transplant community works together to constantly enhance patient safety," Green added. "The lessons we learn from this experience help to improve policies and enhance the transplant community's understanding with a goal of decreasing the risk to transplant recipients as much as possible."

Read about a teen who died from rabies after being bitten by a vampire bat.

Human rabies is rare in the United States, killing roughly two Americans per year. While thousands might be exposed to the virus through contact with raccoons, dogs or bats, drugs designed to prevent the deadly infection are nearly 100 percent successful, according to the U.S. Centers for Disease Control and Prevention.

The three people who received the donor's heart, liver and other kidney were given treatment and remain symptom-free, according to the report.

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Girl Prompts Organ Transplant Policy Review

A family's fight to sidestep a controversial transplant rule and save their 10-year-old daughter has prompted the Organ Procurement and Transplantation Network to review its existing policy that pushes children under 12 to the bottom of the adult organ transplant waiting list regardless of their health. The announcement of the OPTN review came as the family of a second child awaiting a lung transplant sued and won an order to avoid the under-12 rule.

OPTN's executive committee meets June 10 to review data – such as waiting times, mortality rates and organ offers, according to a letter from the president of OPTN's board of directors, Dr. John Roberts, to Health and Human Services Secretary Kathleen Sebelius.

They will determine if a new policy is needed.

"If available data suggest that a change to the lung allocation policy is warranted, the executive committee would be able to approve an interim policy change and expedited plan for implementation at that time," Roberts wrote in the letter.

Read about the Murnaghans' battle to save Sarah

Eleven "priority 1" children younger than 12 years old are currently waiting for lung transplants, according to OPTN data compiled on May 24 for ABCNews.com. Nine under-12-year-olds awaiting lung transplants are categorized as "priority 2."

As a result of an emergency court order, 10-year-old Sarah Murnaghan now has two records in the official organ transplant database: one with her real birthday and one with a birthday to make the system treat her as a 12-year-old.

Sarah is dying of cystic fibrosis and won a federal court order Wednesday to sidestep the controversial transplant rule that had been preventing her from getting new lungs.

The Murnaghan family of Newtown Square, Pa., had been fighting a little-known organ transplant policy that had been effectively pushing its daughter Sarah to the bottom of the adult transplant waiting list because it mandated that adult lungs be offered to all adult patients before they could be offered to someone younger than 12 years old.

The family filed an emergency motion on Wednesday to prevent Secretary of Health and Human Services Kathleen Sebelius from enforcing the policy. Sebelius said Tuesday that she would not make an exception for Sarah.

But on Wednesday afternoon, Federal Judge Michael Baylson ordered Sebelius to stop enforcing the under-12 rule for Sarah "so that she can be considered for receipt of donated lungs from adults based on the medical severity of her condition as compared to the medical severity of persons over 12 in the Organ Procurement and Transplantation Network system." The order is effective immediately and will remain in effect unless the court rules otherwise at a preliminary injunction hearing on June 14.

Bioethicist Art Caplan wrote on Wednesday that politicians and bureaucrats shouldn't decide whether Sarah gets lungs because of the medical complexities of her case.

Speaking to ABCNews.com before the judge ruled in Sarah's favor, he said he didn't expect the Murnaghans to win because it would involve challenging the legitimacy of the entire organ transplant system. That is, unless lawyers could make a pure discrimination case. Otherwise, he said the effort was "doomed to fail."

"I don't think they have any other options to get her on the list," Caplan told ABCNews.com Wednesday after the emergency motion was filed but before the judge ruled in Sarah's favor. "Do I begrudge them the right or the effort to try to do what they can? No."

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Inside Mayo Clinic Organ Transplant Unit

It was just more than a year ago when we touched down in Rochester, Minn. to do a story on the organ transplant unit at Mayo Clinic. Before we could even check our camera mics, we got word that another plane had just landed carrying a red cooler containing a liver for 60-year-old Gordon Karels.

It's the moment more than 100,000 people in the United States are waiting for. Eighteen of them die each day waiting for their organ transplant, according to the U.S. Department of Health and Human Services.

Watch the full story on "Nightline" tonight at 12:35 a.m. ET.

For some, getting a new, healthy organ can happen overnight. For most, the wait is much longer. Sometimes it can take years.

With the cooler in the doctor's hand, we rushed to the hospital to film its arrival and subsequent journey through the winding corridors to the operating room. After his successful transplant and rapid recovery in the days to follow, Karels and his family celebrated.

Also in the hospital was Jessica Danielson, then 30 years old, who was waiting for a heart and liver. At age 19, Danielson was diagnosed with restrictive cardiomyopathy, a rare condition that leads to congestive heart failure and damages the liver.

Web Extra Video: Jessica Danielson Bonds With Woman Who Had Same Condition

Doctors told her that she would either have a heart attack or die from the disease within three years. More than 10 years later, Danielson was still waiting for her double transplant.

Danielson was attached to her IV pump at all times. She had nicknamed it Wilson.

"He's keeping me going," she said last April. "He's pumping medications directly into my heart."

Back then, Danielson said, "I don't think death is in the cards for me, I have way too much to do and I'm doing everything I can to stay strong."

Six weeks later, Danielson finally got a new heart and liver. Her recovery took some months living in Rochester, Minn., at the Gift of Life House, where she had to get used to her new organs.

"I remember the first time I went up an incline in Rochester, and I got to the top of it and teared up," she said. "I'm still in awe of it every day. Carrying the laundry up the stairs -- before it was the hardest thing to do. Now it's just so easy. ... I'm like a normal person now."

"It's a very cool feeling -- hard to explain to someone who has always had a healthy heart -- but it's like magic," Danielson said. "I don't take anything for granted anymore."

Three months after her surgery, Jessica finally went home to Duluth, Minn. "Nightline" caught up with her there last week, shortly after her one-year anniversary of getting her new organs.

Danielson's thicker, curlier hair and healthy coloring made it hard to believe she was the same person we met a year ago in a hospital gown.

Back then, she was pushing her IV pump down the hallway. Last week, she was pushing a shopping cart at the grocery store buying some food for a barbecue with friends.

"I should buy guacamole. It's my favorite thing!" she said.

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