ALASKA is a land of contrast. Not only are there great variations in climate, topog¬ raphy, and ecology, but in its economy as well. While some facets of its technology and economy are highly developed, there are areas which must be considered economically underdeveloped. One of the least developed regions is the Bethel area of southwestern Alaska, where approximately 11,000 persons live in some 50 villages scattered throughout a treeless tundra of 98,116 square miles. Most inhabitants are Eskimos or Atha¬ bascan Indians, whose subsistence economy is based on hunting and fishing. Economic difficul¬ ties are chronic, and a question posed in the report of the 1890 census is pertinent today. "What can these people do to support them¬ selves in a more decent and comfortable mode of life?" (1).

Organ transplant recipients are immunocompromised and at risk for tuberculosis (TB). Although the majority of TB disease in the United States is attributable to reactivation of latent TB infection, donor-derived TB transmission also occurs. 1-3 TB is one of the most common bacterial causes of organ donor-derived infection, and donor-derived TB can result in severe morbidity or mortality. 1,2,4 In early 2018, three solid organ transplant recipients residing in three states but sharing a common organ donor were diagnosed with TB. An investigation was initiated by the Centers for Disease Control and Prevention (CDC) and state and local health departments to determine the source of transmission and prevent further transmission.

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