Cornea transplant kills child,raises many safety questions

NIMHANS study highlights case of 10-yr-old Bangalore girl who received cornea from a donor who may have died of rabies

The National Institute of Mental Health and Neurosciences NIMHANS has reported the death of a 10-year-old girl who received a transplanted cornea from a suspected rabies patient. At a time when India is trying to scale up rates of cadaver organ transplant,the case has raised questions about a possible lack of awareness among doctors on viral infections that can spread from a donor to a recipient.

In a clinical report published in the June issue of National Medical Journal of India,NIMHANSs neurovirology department has highlighted human-to-human transmission of the deadly virus.

The girl was admitted to a private hospital in Bangalore in early 2011 after being diagnosed with congenital hereditary endothelial dystrophy clouding of the cornea since birth. Within two weeks of the corneal transplant procedure,the report says,she had to be re-admitted to the same hospital with headache and symptoms like incoherence,aggression and salivation. She died two days later.

According to Dr S N Madhusudhana,professor and head of the department of neurovirology at NIMHANS,Her total brain sample was sent here,and we confirmed rabies. When the parents of the girl reported no history of animal bite,and no bite marks were found in the autopsy,efforts were made to trace the donor to identify the source of the rabies virus.

The donor was a 26-year-old who died of suspected myocardial infarction heart attack in Chitradurga District Hospital,around 200 km from Bangalore. Official records said he died of a heart attack,but when we spoke to the medical officer,he said that was only a suspicion,and that he also had some neurological symptoms. No post mortem was conducted and no tests were carried out to check whether he had rabies, Dr Madhusudhan said.

A 55-year-old woman who received the second cornea from the same donor was treated for rabies immediately after the transplant,and she has survived.

Indiscriminate donation and transplant of cornea,the authors say,warrants an investigation in a rabies endemic country like India. Medical literature shows that in the last decade,eight cases of rabies transmitted through donated organs were reported. Two of these were from India reported by AIIMS in 1988,two each from Thailand and Iran,and one each from the USA and France. In the last two cases,examination of brain samples confirmed rabies.

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Doctors say that proper recording of the cause of death is key because donated organs are almost never screened for rabies. Dr Radhika Tandon,opthalmology consultant and in-charge of the National Eye Bank at AIIMS,said,In our country,serological tests are performed on all donated organs for HIV,Hepatitis B,and sexually transmitted diseases like syphilis. But any viral infectious disease like rabies is a potential contra-indication for donation and it is fundamental to establish the proper cause of death in records,since we are not conducting tests for it.