NC airman at center of rabies case was outdoorsman

Tuesday - 3/19/2013, 11:20am EDT

MARTHA WAGGONER
Associated Press

TRENTON, N.C. (AP) -- When William Edward Small told his father that he'd signed an organ donor card, it came as no surprise. "Little Ed" had been that way his whole life, his dad said.

"If he had it, he would give it to you," said his father, also named William Small. "Anything that somebody wanted, all they had to do was ask. And that's just the type of person he was."

Officials say that generosity of spirit may have inadvertently cost another man his life.

Health officials said last week that a Maryland man had died because the kidney he received from the 20-year-old airman in late 2011 was infected with rabies. As his eyes filled with tears in his living room Monday, it was as if William Small were losing his youngest child all over again.

"The bad part for me is knowing that someone actually died because of it -- thinking that he thought he was doing everything right," the elder Small said of his boy, whose heart, liver and other kidney were transplanted into other recipients.

Alecia Mercer, the mother of the younger Small's 3-year-old son, confirmed Monday that the Trenton, N.C., man was the donor of the infected organs. The same casualty officer who informed her of his death in September 2011 came to deliver the news at her Trenton home last week.

"It was kind of a deja-vu," she said, sitting on the front porch swing Monday with her son, Shane.

A year and a half ago, officials told Small's loved ones that he had died of food poisoning or a stomach virus. Now, they must live with the knowledge that one man is dead, and several others may have been infected.

"I was very suspicious over that," Alecia Mercer said of the initial cause of death she received from military officials. "At first they said it was poison from a fish, and he fished a lot. I knew he knew all types of fish."

Small went through basic training in Texas before going to Florida to train as an aviation mechanic.

Small, who was training at Pensacola Naval Air Station, visited a base clinic in August 2011 for abdominal pain and vomiting, Defense Department officials said. Four days later, he was transferred to a civilian hospital, where he died.

During a telephone call shortly before he became ill, Small had told his father he got sick after eating a puppy drum he'd caught in the Gulf of Mexico, but had gotten better. By the time his father heard of the relapse, the younger Small was on a respirator.

The organs were offered for transplant by LifeQuest Organ Recovery Services of Gainesville, Fla., said Kathy Giery, the group's director of donor program development.

Giery said the hospital's diagnosis at the time of death was that his illness was caused by food poisoning from ciguatera, a toxin sometimes found in large saltwater fish, including grouper, red snapper and sea bass. The Defense Department had said the donor died of severe stomach and intestinal inflammation with complications including dehydration and seizure. The Florida Department of Health has said he died of encephalitis -- a brain inflammation -- of unknown origin.

Giery said the donor -- an avid hunter and fisherman -- wasn't tested for rabies because his symptoms didn't raise a red flag for infection.

"There was no testing done for rabies at any point in the process because nobody suspected rabies," she said.

As the "host organ procurement organization," LifeQuest was responsible for the quality of the organs it offered when it posted their availability on a national database maintained by the United Network for Organ Sharing.

Giery said every donor program does extensive testing of every potential donor, but rabies isn't part of the routine screening, partly because human cases are so rare. It causes just one to three deaths a year in the United States, according to the federal Centers for Disease Control and Prevention.

Federal guidelines published last year for evaluating organ donors with encephalitis urge "extreme caution" if the suspected cause is a viral pathogen, such as rabies. Giery said those guidelines weren't in place when the organs were offered in 2011.

"For our cases today and going forward, I think everyone would be looking at this through a different lens," she said.

When a Maryland man who had received one of Small's kidneys in 2011 died last week of rabies, further testing revealed Small had the infection. His heart, liver and another kidney went to recipients in Florida, Georgia and Illinois; those recipients started getting the vaccine this month, and none has rabies symptoms.