Part of the reason that episodes like this are so rare is that waves of screening protocols are in place to prevent diseased organs from being passed on to recipients. Before transplanting any organ, doctors routinely screen donor tissues for viral and bacterial infections. They will also conduct comprehensive patient and family histories to determine whether the donor had dangerous behaviors, such as a history of intravenous drug abuse, or whether they may have exposed themselves to less obvious infections. Even vague symptoms, such as unexplained fever or headache, are investigated.
"The system does everything reasonable to prevent disease transmission," said Dr. Vivian Tellis, head of the kidney transplant program at Montefiore Medical Center in New York.
But the precautions, while comprehensive, are not fail-safe. As in this case, doctors do not always know the exact reasons behind a patient's demise until their organs have been transplanted. And doctors have long recognized that the immune system suppression that organ recipients must undergo in order to be able to accept donated organs puts them at an increased risk of developing cancer from transplanted organs.
"Before it is diagnosed, cancer usually exists at some point as a microscopic focus, which often precludes attempts to detect it early and frustrates clinicians worldwide," said Dr. Jason Schwartz, assistant professor of transplant surgery at the University of Utah in Salt Lake City. "It is easy to see that if a transplant occurred from a donor with microscopic disease, it would be possible to transmit cancerous cells to a recipient."
And cancer is just one of a sea of possibilities when it comes to the diseases that can potentially come along with a donated organ.
"The important thing to remember is that all the transplanted organs are used organs and come from other individuals who have died," Loyola University's Brems said. "Therefore, it is inevitable that an organ will get used from a donor who has an undiagnosed disease."
Complicating the situation is that decisions about organ transplantation often need to be made very quickly, as precious donated organs do not survive long past their donors unless they are implanted into a recipient's body shortly after the donor's death.
"Once death has occurred, there is a finite amount of time before irreversible damage occurs in the organs," Tellis, of the Montefiore Medical Center, said.
But the immediate nature of the procedure still begs the question: Could anything have been done differently to further protect the lives and health of those slated to receive Alex's diseased organs?
Not likely, Tellis noted. She said that it appears the 15-year-old had all the signs of meningitis, and that doctors treated him for this condition. The normal battery of screening tests would not have pointed to his cancer. And even the autopsy results that revealed the true nature of his illness came only days after his death — by which time his organs, if left untransplanted, certainly would not have been viable.
"Could the diagnosis have been made earlier? That depends upon what tests were done, and how they were interpreted," Tellis said. "Conceivably, even with CT scans and/or MRIs, the diagnosis could have been obscured.