International sign for medicineThe recent discovery of a rare amoebic infection in two organ transplant recipients catapulted an unusual, but catastrophic, risk of organ transplantation into international headlines. The Centers for Disease Control reported that four people in three states received organs from a patient suffering from neurological problems who died at the University of Mississippi Medical Center in November. Two of the organ recipients are now critically ill. Transplant patients are particularly susceptible to developing severe symptoms of infectious diseases, as they must be given drugs that weaken the immune system in order to prevent organ rejection. Although organ donors are routinely tested for common pathogens such as the hepatitis and human immunodeficiency viruses, unusual infectious agents may escape the screening process. According to Dr. Kenneth Kokko, the medical director of kidney transplants at the University of Mississippi Medical Center, “We test for the known harmful diseases, but there’s not a test for every single pathogen out there.” Though the occurrence of Balamuthia mandrillaris amoeba is extremely rare, even more common entities, such as bacterial infections, tuberculosis, rabies, and cancer may evade detection prior to the harvesting of organs. Many organ donors are young, healthy victims of severe trauma who have had little or no medical screening. Such patients may be asymptomatic carriers of chronic infections or have undiagnosed tumors. For example, an Oregon donor in his 40s with a history of alcohol abuse who tested negative for hepatitis C, was later found to have the virus. Ninety one different tissues and organs were given to forty patients over a 22 month period. Eight patients were infected, and two later died. In this case, the donor escaped detection because of the eight to ten week window between infection and the development of detectable blood markers for the disease. All these cases have been reported in the country with the reputation for the highest standards in medical care. Of course, the potential transmission of life threatening illness is potentially even greater for those wishing to travel overseas for an organ transplant. Although there are very few U.S. residents who do this today, the number is likely to grow as the availability of organ donors fails to keep pace with the demand. Indeed, over 9,000 people per year in the U.S. die waiting for organ transplants. Given the choice between succumbing and finding a donor overseas, most people would be willing to take the risk of an exotic, undetected illness to receive a life saving transplant. Even in the United States, transplant centers seem to be more accepting of deceased donors with high risk behaviors, such as intravenous drug use. The short interval required to match sick patients with donors also increases the risk of missing a transmissible disease that is not routinely tested for. In conclusion, “caveat emptor” or “let the buyer beware” As the widow of one unfortunate recipient commented “The kidney transplant was supposed to be the gift of life but the infection that came with it ended up taking it away.”


About The Author

Frank Gillingham, M.D. serves as Chief Medical Director for HTH Worldwide. Frank has led HTH Worldwide's international business development efforts in Europe and Canada and has been a guest speaker at international business conferences and has authored a series of articles on travel medicine, including pieces on travel information available on the Internet and the role of physicians working with travel insurers. Frank is a Board-Certified Internist and Emergency Medicine Specialist. He is also a private emergency physician in Southern California and a former emergency department director and member of the UCLA emergency department staff. Frank completed residency training at Los Angeles County/USC Medical Center, received his M.D. from Albert Einstein College of Medicine and his B.A. from the University of Pennsylvania .

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