Three people have most likely been infected with rabies in Germany following an organ transplant from a woman thought to have contracted the illness before her death. All three are in an extremely critical situation, while three others who also received organs from the same donor are in good health and receiving treatment to prevent the illness.

The German Organ Transplant Foundation said that this would be the first time the deadly rabies virus had been transmitted via transplantation in Germany.

A routine case

It all looked like a routine case of organ transplantation. In December, the organs of a deceased donor were delivered from a hospital in the town of Mainz to six patients in hospitals all over Germany.

The donor had died of heart failure without showing any signs of rabies, says Manfred Thelen, the head of the hospital where the organs were extracted.

"It was a young woman of 26 years who was delivered to the hospital in late December," he explained. "Months before her death she had been on a trekking tour in India. Later she fell ill in a different region in Germany, suffered a heart attack and was admitted here."

Five cases in 20 years

The fact that the young woman had probably caught the virus while travelling in India was only discovered after three recipients of her organs fell ill in January, showing typical signs of the disease.

In some cases, rabies can take several months to appear. But once it breaks out it is usually fatal. In developing countries, thousands die of rabies every year, while only five cases have been reported in Germany in the past 20 years -- one reason why organs are not routinely screened for the rabies virus before being transplanted. Doctors also say it's impossible to test organ donors for rabies in the short space of time between death and transplantation.

"It's impossible to test for a possible rabies infection," said Thelen. "It is a terrible tragedy that the organs were infected, but the situation could not have been avoided."

Since the young woman had shown no signs of the disease, her organs were extracted and delivered to six patients. Three of them are now reported to be in an extremely critical situation, with two of them in a coma.

However, three other patients who also received organs from the infected woman have not shown any symptoms yet and are receiving treatment to prevent an outbreak of the illness.

"Organ transplants save lives"

The German Organ Transplantation Foundation, which announced the findings on Wednesday, said that it would be the first time the virus had been transmitted via transplantation in Germany. But the president of the foundation Günter Kirsten said there was no need to question the whole practice of organ transplantation:

"Organ transplantation saves lives," he said. "People die while waiting to receive an organ and we know that in this desperate situation many are ready to take a certain risk. You have to be aware that modern medicine -- and of course also transplantation -- always carries a risk."