Finding into death of Carmelina Rachela Sirianni

63y · Female·Lymphocytic choriomeningitis virus (LCMV)-like virus infection; post failed renal transplant

A 63-year-old woman received a renal transplant from a cadaveric donor who had died of cerebral hemorrhage. She developed delayed graft function and deteriorated post-operatively, ultimately dying from a novel lymphocytic choriomeningitis-like virus (LCMV) transmitted via the donor organ. The donor and all three recipients of his organs died within days of each other. While the screening process was reasonable for the era, clinical lessons include: the need to improve direct access to complete donor referral forms by transplant teams (rather than filtered telephone communication); inquiry about donor contact with rodents/hamsters (potential LCMV vector); and robust post-transplant inter-hospital communication when multiple recipients receive organs from one donor. Family communication about the recipient's deterioration was inadequate. The death was neither foreseeable nor preventable at the time, as this novel arenavirus was unknown and no screening test existed.