India: Kidney recipient and donor both died of unidentifed paralytic illness

[Emily]

Sounds like this happened in 2009.

http://articles.timesofindia.indiatimes.com/2011-07-09/mumbai/29754824_1_cadaver-kidney-transplant-organ-distribution

Organ distribution norms 'transparent'
Sumitra Deb Roy, TNN Jul 9, 2011, 12.21am IST
[snip]
A five-member committee set-up by DHS was probing the death of cadaver kidney recipient Flavian Kandhari (33) within two months of the transplant, and of the same disorder the donor died of. Both recipient and donor died of the Guillain Barre Syndrome (GBS), which is medically termed non-transmissible and non-contagious....

 

[alert]

Re: India: Kidney recipient and donor both died of the Guillain Barre Syndrome (GBS)

Re: India: Kidney recipient and donor both died of the Guillain Barre Syndrome (GBS)

It is standard practice in the United States NOT to transplant any blood or organs from a victim who dies of an undiagnosed neulological illness to prevent iatrogenic spread of rabies virus, despite its rarity here. The explanation being, that it takes longer to confirm that donor is rabies-free than the organs would last prior to donation.

Rabies is endemic in India, and has to be one of the primary suspects under investigation, especially in light of the fact that both the donor and recipient died.

The other, less likely, explanation might be polio. India was one of four countries in which wild poliovirus was endemic (www.polioeradication.org) in 2009, and as an enterovirus, polio could certainly be transmitted this way. However, the incubation period of two months here might be too long, polio is rarely fatal, and all AFP cases in India are tested for polio as part of the eradication effort.

 

[Emily]

Re: India: Kidney recipient and donor both died of the Guillain Barre Syndrome (GBS)

Re: India: Kidney recipient and donor both died of the Guillain Barre Syndrome (GBS)

Alert, I agree this does not sound like the safest protocol, but apparently if a death is diagnosed as due to an autoimmune cause, even one with neurological signs, the organs are eligible for transplantation here in the US, with risk assessment left up to the individual transplant centers.

http://www.flutrackers.com/forum/showthread.php?t=137117
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5936a1.htm

Organ procurement organizations (OPOs) and transplant centers should be aware of the potential for Balamuthia infection in donors with encephalitis of uncertain etiology, and OPOs should communicate this elevated risk for infection to transplant centers so they can make an informed risk assessment in the decision to accept an organ.

http://spotlight.vitals.com/2009/12/dr-shirley-schlessinger-explains-the-need-for-stricter-donor-rules/

?There has to be a balance between safety and availability, but right now all the emphasis in on availability,? say Dr. Matthew Keuhnert, who oversees blood transfusion and transplant safety at the CDC.

Read more: http://spotlight.vitals.com/2009/12...-need-for-stricter-donor-rules/#ixzz1U0uZIoGd

 

[alert]

Re: India: Kidney recipient and donor both died of the Guillain Barre Syndrome (GBS)

Re: India: Kidney recipient and donor both died of the Guillain Barre Syndrome (GBS)

Good point, Emily. There's another one I hadn't thought of. Balamuthia is one of the "brain-eating amoebas" (http://www.wired.com/wiredscience/2010/09/brain-amoebas-organ-transplants-brrr/) that would be a possible explanation here. A further re-read of that incident looks a lot like this, including the paralytic symptoms, the errant assumption of an immune reaction, and even the extended incubation period.

It sure looks like this is not a case of GBS but rather an undiagnosed infectious disease.

Even though the incident is two years old, perhaps we should send this to ProMED?

 

[Emily]

Re: India: Kidney recipient and donor both died of unidentifed paralytic illness

Good find on the Wired article, alert!

Even though the incident is two years old, perhaps we should send this to ProMED?

That sounds like a good idea. (If RoRo agrees)

http://www.flutrackers.com/forum/showthread.php?t=168037

 

[Ronan Kelly]

Re: India: Kidney recipient and donor both died of unidentifed paralytic illness

Sent to ProMed along with a link to the MMWR referred to in the McKenna Wired article. Thank you both for all of your good work!

 

[sharon sanders]

Re: India: Kidney recipient and donor both died of unidentifed paralytic illness

Thanks everyone!