Infected organs kill 3 recipients

In a rare and tragic chain of events, three transplant recipients, including two in Massachusetts, have died since mid-April after receiving organs contaminated with a virus that the donor had apparently contracted from her pet hamster. A fourth organ recipient became seriously ill with the virus, but is expected to live, Rhode Island public health officials said yesterday.

The lymphocytic choriomeningitis virus, or LCMV, is usually mild in people and did not cause the death of the organ donor, who suffered a fatal stroke, Rhode Island officials said. People who have received organ transplants, however, must take antirejection drugs that severely weaken their immune system, making them far more vulnerable to infection. The federal Centers for Disease Control and Prevention has records of just one other case, in Wisconsin in December 2003, in which a transplant recipient died as a result of receiving organs infected with the virus.

The patient deaths should spur efforts to improve the disease-reporting system after transplants so that patterns become clear more quickly, said Dr. Jay Fishman, director of the transplant infectious disease program at Massachusetts General Hospital. ''This is a freak occurrence," he said, ''but it foreshadows changes in reporting unusual infectious events after transplant. This is a system that needs to be enhanced."

The deaths also prompted public health officials to issue warnings to women in the first or second trimester of pregnancy to avoid contact with rodents and their feces and urine, which can carry the virus. LCMV is associated with miscarriage and neurological illness in newborns, said Dr. David R. Gifford, Rhode Island's health director.

''I don't think the general public should be too worried," Gifford said in a telephone interview. ''The general public should know that rodents cause disease and [that] you should take appropriate precautions when changing their litter."

The dead transplant recipients included a patient who had received two lungs at Brigham and Women's Hospital, a man who had received a liver at Mass. General, and a kidney recipient at Rhode Island Hospital in Providence, officials said. The surviving transplant recipient had also undergone a kidney transplant at Rhode Island Hospital. All three hospitals stressed that the contamination posed no threat to other patients or staff.

The deaths startled everyone involved, including officials at New England Organ Bank, which administers the regional transplant system. Spokesman Sean Fitzpatrick said the organ bank requires that donors be tested for major infectious diseases such as HIV and hepatitis and also screens out organ donations from people who seem sick or might have been exposed to disease, such as former prisoners. The organ bank, however, doesn't test for LCVM, because the virus is one of hundreds of diseases so rare that it is not worth the added delays for an already overburdened transplant system, Fitzpatrick said.

''In transplants, there is a very real risk-benefit analysis that goes on," he said. ''You have someone who is sick and may die in a certain period of time and that is known, and you balance that with the unknowns. This is an example of the unknowns."

Fitzpatrick compared the tragedy to the death of three transplant recipients in Texas last year because the donor had contracted rabies and did not know it at the time of his death.

Dr. Alfred DeMaria, director of communicable disease control in Massachusetts, said the virus is common in wild rodents, but far less so in pets. In people, it is rarely fatal and most often produces headaches or flulike symptoms. ''It's one of those infections in most people where it's hardly noticed," he said.

Officials at the PETsMART store in Warwick, R.I., where the infected hamster was sold, voluntarily quarantined the store's rodents last week after the CDC told them of the investigation. On Friday the CDC took 36 of the animals for testing and 24 more yesterday, a company spokeswoman said.

''We're working very closely with the [Rhode Island] Health Department and the CDC to do whatever we can to help them with their investigation," said Jennifer Pflugfelder, spokeswoman for PETsMART Inc., which is based in Phoenix.

The chain of events began March 19 when the organ donor, a woman, purchased a pet hamster infected with LCMV, though neither she nor the PETsMART staff knew it. A spokesman for the chain said the store doesn't test its rodents for LCMV, because the virus has rarely been a problem. The test for LCMV requires killing the animals, spokesman Bruce Richardson added.

The donor died in early April, and after extensive blood and tissue sampling, her family donated her lungs, kidneys, liver, and corneas, according to Rhode Island officials. The corneas were sent to patients outside New England and apparently caused no adverse health effects, but the other organs were implanted April 10 and 11 in patients in Massachusetts and Rhode Island, Gifford said.

Almost immediately, infectious disease doctors at Mass. General noticed that the liver recipient ''just wasn't doing quite as well as he should have," Fishman said.

The man had a low-grade fever, and two to three weeks after the transplant, ''the man's liver function began to deteriorate and, within about five to seven days, he had died," Fishman said.

Also in late April or early May, Brigham and Women's reported that a lung transplant recipient had contracted a viral infection.

In Providence, infectious disease specialists had two kidney transplant recipients sick with a virus. Fishman said an infectious disease doctor had lowered the dose of antirejection drugs for one recipient, which may have been one of the reasons he survived. Officials declined to provide the names or other details about the donor or recipients, to protect their privacy.

Officials at New England Organ Bank, working with the hospitals, discovered that all the sick people had received organs from the same donor, and the officials notified public health officials in Rhode Island and Massachusetts, as well as the CDC.

The CDC determined that the patients all suffered from LCMV, but when they tested blood and tissue samples preserved from the donor, they couldn't find any signs of the virus. That's not surprising, because the donor never had any symptoms, Rhode Island officials said. The woman's hamster showed symptoms of LCMV and tested positive.

The donor's remaining tissue has been removed from organ banks, Gifford said.

Scott Allen can be reached at allen@globe.com.