Four die of rabies in transplanted tissues.

Five people recently received tissue transplants from a man who had died, as it turns out, from an undiagnosed rabies infection. All the recipients have since died, four of them from the incurable neurological disease.

The donor was hospitalized in Texas in early May and diagnosed with a brain hemorrhage. He died soon afterward, and physicians attributed his death to noninfectious causes. His family agreed to donate his organs, and physicians at the hospital screened his blood for a standard set of pathogens that doesn't include the rabies virus.

On May 4, surgeons at Baylor University Medical Center at Dallas transplanted the man's liver and both of his kidneys into separate patients, who were subsequently released from the hospital. In June, all three organ recipients returned to the hospital with early signs of rabies, including uncontrolled movements, lethargy, and abnormal behavior. Rabies can be cured by early treatment, but once symptoms appear, the disease is almost always fatal.

Another patient in Texas received an artery from the same donor and remained in the hospital, where he died of rabies. Surgeons at an Alabama hospital transplanted the man's lungs into a fifth patient, who died of surgical complications.

Federal agencies are now reviewing screening practices for donated organs and tissues, which had previously been linked to only eight eases of rabies, none of them in the United States.

Because it takes a day to screen for rabies, and donated organs must be used as soon after the donor's death as possible, it may be impractical to add rabies to the standard screening procedures.--B.H.