It is a medical miracle that organ transplantation has progressed so far. The New York Times reports on two transplants that transmitted the West Nile virus. The article raises difficult questions of screening and testing that deserve serious study and discussion.
In the antiseptic prose of medical journals, he was "the lung recipient," she "the liver recipient." In real life, they were two desperately ill people who received transplants last August from the same organ donor, a brain-dead accident victim. Thanks to the surgery, they had a second chance at life. Or so it seemed.
For two weeks they fared well, he at the University of Pittsburgh and she at New York University Medical Center. But then, suddenly, they began to run fevers, deteriorate mentally and struggle for breath. Seizures and paralysis followed, and they sank into comas.
Tests found the West Nile virus. Both patients had been infected by the donor, whose blood was tested only after the recipients got sick. Two other patients received his kidneys, but remained well. The disease took its worst possible course in the liver and lung recipients, causing encephalitis, a brain infection.
Neither recovered. The woman who received the liver remained paralyzed and unresponsive, on a ventilator, according to her surgeon, Dr. Lewis W. Teperman, director of transplantation at New York University. After 68 days her family withdrew life support, and she died. Dr. Teperman said he did not have the family's permission to identify her.
The second patient, Dr. Sabih Aburegiaba, 69, is still alive. He is on a ventilator at a hospital in Queens, barely responsive, his prognosis uncertain and his family struggling to find the proper level of care for him.
Dr. Matthew Kuehnert, an expert on transfusion and transplant safety at the Centers for Disease Control and Prevention, said: "I think organ safety as concerns infectious disease transmission is really underappreciated. It's something that really needs to be looked at more closely."
Dr. Aburegiaba is in a kind of medical limbo. He has been shuttled to one institution after another, largely because of insurance issues and the payers' doubts about his potential to recover. At this point, Ms. Linehan said, the family hopes he will become stable enough to be taken home and cared for there, even on a ventilator.
The family is distraught, but also frustrated and angry, wondering why the donor was not tested, why the diagnosis was not made sooner, and whether the outcome would have been any different if it had. They say they feel that a man who devoted his career to saving the lives of others has been let down by his own profession.