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Donor Tissue and Organs Life Savers or Deadly Time Bombs?Jul 1, 2006 It was not very long ago that advances in science made the prospect of widespread transplanting of tissue from cadavers and organs from live donors one of the greatest medical breakthroughs in history. The availability of a virtually limitless supply of donor tissue and organs was seen as a means by which countless lives could be saved, prolonged, or improved.
For many, this promise has been fulfilled and the donated tissue or organ has truly been a gift that either saved or vastly improved the quality of the recipient’s life. Others, however, have been plunged into a nightmare that has either caused untold suffering or death. As it turns out, there is a dark side to tissue and organ transplantation that has turned this once promising field of medicine into something akin to a deadly game of Russian roulette.
Contamination of donor tissue or organs has become a significant problem and no real solution is in sight. Things are actually getting worse. The crisis is the product of a combination of the following factors:
- Unscrupulous individuals engaging in fraudulent practices designed to profit from the sale of unscreened, diseased, and otherwise unacceptable tissue.
- The appearance of diseases, viruses, and bacteria for which no effective or economically feasible screening tests exist.
- The realization that certain serious diseases, viruses, and bacteria that were not believed to pose a treat to transplant recipients actually can be transmitted.
- A single contaminated donor-source may be processed into multiple transplants and shipped throughout the United States and even to numerous foreign countries.
- Inadequate, incompatible (from state to state or country to country), and negligently performed screening and tracking practices.
Over the past several years, the following reported cases of transplant contamination have been reported:
- Hepatitis C – Reports go back as far as 1992 and 1995. In 2002, however, more than 40 people received contaminated tissue or organs as a result of the failure by an Oregon tissue bank to detect the disease in a single donor. It is suspected that one death occurred as a result of this lapse in screening.
- Hepatitis B – The earliest reported case of transplant contamination dates back to 1954.
- Fungus – A serious problem in heart valve transplants with over 500 case of contamination and approximately 200 deaths each year.
- Clostridium – In 2001, a man in Minnesota died as a result of a “flesh eating” virus known as Clostridium. Investigators found more than 60 other transplants in 20 states that were contaminated with Clostridium and other types of bacteria. Some tissue samples were infected with multiple types of bacteria.
- West Nile virus – In 2002 several transplant recipients were exposed to organs contaminated with the West Nile virus developing severe symptoms such as high fever and neurological impairment.
- Rabies – In 2004, four deaths were linked to three organ and one tissue transplants.
- Tuberculosis – At least one case of TB traceable to a tissue transplant was reported in 1953.
- Cytomegalovirus (CMV) – A genus of Herpes viruses. CMV especially attacks salivary glands and may also be devastating or even fatal to and patients who are immunocompromised such as those with HIV/AIDS or organ transplant recipients. There have been reports of CMV occurring in cases involving skin transplants.
- HIV – Between 1983 and 1992 there were at least four tissue transplant cases involving the HIV virus. There have also been a number of cases wherein the HIV virus was spread through contaminated blood transfusions. Arthur Ashe, the tennis legend, died in 1993 from the complications of AIDS that developed as a result of a blood transfusion, during one of two heart surgeries, contaminated with the HIV virus.
- Chagas Disease – A parasite that is common in Latin America was diagnosed in three recipients of organs from the same donor in 2001.
- Lymphocytic choriomeningitis virus (LCMV) – This virus, although rare, presents a particularly disturbing problem. Just last year, three people died in New England after receiving organs, from a common donor, contaminated with LCMV, a rodent virus. Four people had also died in Wisconsin in December of 2003 after receiving organs also infected with LCMV.
LCMV contamination: In July of 2005, infected hamsters were found at Mid-South Distributors, a pet distribution center in Ohio. One of these hamsters was linked to the deaths of three organ transplant recipients in Rhode Island and Massachusetts.
An investigation by the Centers for Disease Control and Prevention (CDC) first linked Mid-South to the original infected hamster and later found more infected hamsters at the site. Quarantine was soon put into effect for 4,000 small pets that were later put to sleep.
Two kidneys, a liver, and two lungs were taken from a donor in Rhode Island. Although the donor was a carrier of the virus, she apparently was not infected. These organs were then transplanted into four patients in Massachusetts and Rhode Island. Three of the recipients died a few weeks after receiving the organs. Tests later revealed that the original donor’s hamster was infected with LCMV.
This discovery came two months after the first report of the deaths of at least six transplant patients after being infected with LCMV.
Approximately 5% of all rodents carry LCMV. The virus is usually spread to humans through contact with infected animals or their feces or urine.
Interestingly, about 2% of the general population has antibodies to the virus meaning that they have been exposed to the virus at some point in their lives. Healthy people are usually not affected by the virus.
However, for individuals whose immune systems have been compromised by diseases like cancer or AIDS or as a result of taking immune-suppressing drugs designed to prevent organ rejection, LCMV can become a deadly virus.
In December 2003, three organ recipients died in Wisconsin under similar circumstances. At the time, however, the Wisconsin deaths were not considered to be a public health threat at the time since there was apparently no evidence that the virus was spread from person-to-person. Thus, the incident was not widely discussed in the media.
Unfortunately, the doctors who oversaw the organ transplants in New England did not learn about the circumstances of the Wisconsin deaths until it was too late. Dr. Staci Fischer, one of the New England doctors, contacted the CDC and learned about the connection between LCVM and the organ donor’s infected hamster. Dr. Fischer said that the last patient could have been saved if she had received the information earlier.
Following these events, the CDC, the Food and Drug Administration (FDA), state health officials, and medical experts started conducting an investigation into the fatalities. They also asked doctors and hospitals to start monitoring all organ transplant patients and blood transfusion recipients for any unusual illnesses. They also recommended careful testing of all donated organs and blood.
The CDC also issued some new guidelines in August of 2005 for minimizing the risk of the spread of LCMV from rodents to humans. The guidelines stated that pregnant women and people with compromised immune systems should try and avoid contact with rodents whenever possible.
In May of 2006, an article published in the New England Journal of Medicine called for pet suppliers to do their part by screening for LCMV at their facilities. Doctors will also start screening for the virus although currently, no commercial test exists for LCMV and it is not one of the viruses for which tests are routinely performed on organs.
Following the 2005 incidents, MidSouth Distributors was fined $25,000 and forced to close its doors for a period of five years. Even when the facility is allowed to reopen, they will be subject to a two-year probation period during which an animal care specialist and veterinary medical officer will conduct surprise inspections of the facility.
- Stolen Body Parts – Stolen, improperly obtained, and fraudulently documented body parts have now become big business. Unfortunately, they have also spread death and disease throughout the United States and to other countries and have been linked to transplant recipients developing a number of extremely serious conditions including HIV/AIDS, syphilis, and hepatitis B and C.
Although warnings and recalls have been issued by the FDA and the CDC, there is no way to remove the diseased tissue from the thousands of patients who may have unknowingly received it in the past two years.
While strict processing regulations with respect to screening, radiation, and treatment of body parts and human tissue with anti-bacterial and anti-viral drugs should prevent the spread of disease from infected products from the illegal sources, there is no guarantee that this will happen in all cases. In fact, it appears that precisely the opposite is true and that some patients have been infected by the diseased tissue.
In March 2004, UCLA's Director of the Willed Body Program, Henry Reid, was arrested and a criminal investigation launched into the activities of others at the University of California for the illegal sale of body parts. That series of events focused attention on the fact that one cadaver could be dismembered and sold in parts for over $200,000 to the pharmaceutical and medical industries.
Advances in surgery and other medical techniques also fueled an underground trade in transplantable tissues and organs that quickly became a multi-billion a year business.
The probe of the UCLA Medical Center went back as far as 1998. Also arrested in March 2004 was Ernest Nelson, a body parts dealer who claimed to have paid Reid over $700,000 for permission to enter the UCLA body freezer and steal parts from some 800 cadavers.
The cadavers stored at the university were supposed to be used exclusively by medical students for study. Nelson provided documentation to authorities that allegedly proved high level UCLA administrators had knowledge of and approved the secret sale of the body parts.
Reid, employees under his supervision, and others at the UCLA Medical Center appeared to have avoided detection by keeping some of the donated cadavers “off the books” and by possibly accepting cadavers that were never recorded.
In addition to such scandals as the University of California Medical Center being used to "launder" cadaver parts, are numerous underground clinics that perform transplants involving illegally obtained organs.
One of the serious problems with this illegal trafficking is that it could result in the circumventing of all screening and testing procedures set up and maintained to ensure recipients will not receive diseased or otherwise contaminated tissue or organs. With the possibility that dozens of unsuspecting patients could receive tissue or bone from a single diseased cadaver, the potential for a medical catastrophe cannot be minimized.
Currently, the nationwide scandal had its origin in New York City. In Brooklyn, alone, some 1,000 corpses are part of the District Attorney's investigations into the theft and sale of bones and other body parts removed from fresh corpses at several funeral homes, without permission, and sold to BioMedical Tissue Services, a Fort Lee, N.J., tissue recovery company. Bones and body parts were replaced with everything from broomsticks and pipes to plumbing supplies.
These illegally removed body parts include bones for orthopedic procedures and dental implants, tendons and ligaments for those with tears or other damage, and skin for burn victims and cosmetic surgery.
Unfortunately, the tissue and bones were harvested without regard to the cause of death and without proper screening for diseases and other contamination.
As a result, Lifecell Inc. announced a voluntary recall of three products made from body parts acquired from BioMedical Tissue Services. They are AlloDerm, used for plastic surgery, burn and periodontal procedures; Repliform used for gynecological and urological surgical procedures; and GraftJacket, used for orthopedic applications and lower extremity wounds.
In addition, many medical facilities and hospitals have been forced to notify patients of the possibility that they may have contracted any one or more of a number of serious and even life-threatening diseases from the bone or tissue grafts they received. Health officials are concerned that tens of thousands of people across the country may have been exposed by untested parts from BioMedical. Hundreds are already being tested for various diseases.
Famed forensic pathologist, Dr. Cyril Wecht, explained how the New York scandal occurred. He stated that when bodies were sent to certain Brooklyn funeral homes for the necessary embalming, consent forms were forged giving permission to remove “various bones, tendons, ligaments, heart valves, teeth and so on. Not major organs like heart and lungs and kidneys, because that just could not work.”
According to Wecht this isn’t the first time something like this has happened. “I’ve been involved in some cases over the years…they were doing this with eyes. A funeral director tied in with an autopsy technician in a large hospital, and they were taking out people’s eyes and selling them to foreign countries.”
Dr. Wecht noted that in forging the necessary documents, ages and causes of death were changed. “They eliminated things like cancer and put in heart disease.”
Clearly, the notion of tissue and organ transplantation as a revolutionary medical breakthrough must now be re-evaluated in light of dangerous contamination traceable to natural and man-made causes. More reliable screening and tracking procedures must be devised including a wider range of tests that would be able to detect the presence of potentially deadly viruses like LCMV and CMV.
If you believe that you or a loved one has been the recipient of a contaminated transplant or if you suspect that a deceased relative may have had any part of their body removed without authorization, you may contact Parker & Waichman at www.yourlawyer.com for a free case evaluation.