His family and ex-girlfriend were first told he died of fish poisoning. Later, some were told it was a stomach virus. Now, a year and a half later, his relatives have been told he died of rabies and the people who received his donated organs might have been infected. One man in Maryland died after receiving a kidney in 2011.
"I was very suspicious over that," said Alecia Mercer, the mother of Small's 3-year-old son, about the first cause of death that military officials told her. "At first they said it was poison from a fish, and he fished a lot. I knew he knew all types of fish. Then it came back it that it was a stomach virus. I just couldn't believe that."
Mercer's mother, Anna Mercer, said she was also suspicious and asked if the family should take any precautions for Small's son. "I accepted it because that was on his death certificate," she said. "But something just didn't set right with me."
Small went through basic training in Texas before going to Florida to train as an aviation mechanic. He visited a clinic at the Pensacola Naval Air Station in August 2011 for abdominal pain and vomiting and was transferred four days later to a civilian hospital where he died, a Defense Department spokeswoman said last week.
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 has 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 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 per year in the United States, according to the CDC.
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 man who had received one of Small's kidneys in 2011 died last week of rabies, that led to further testing of Small and it was discovered that he 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.
William Small, father of the dead man, said Monday that he was sorry one person died from his son's organs, but he took comfort knowing that others were still alive.
"The bad part for me is knowing that someone actually died because of it - thinking that he thought he was doing everything right," said the elder Small, who left the Air Force in 1976 after five years of service. "But then, too, looking back on the other part, there are three people still alive because of him."
The father and son had shared a single-wide mobile home in Trenton, N.C., that sat on the site of their former wood-frame home, which was torn down. The son's room now has no furniture, but the pelts of three raccoons, a beaver and a grey fox are on the wall, along with an unframed baby photo of Small's son, Shane, tacked to the wall. Fishing rods stand in the corner.
Small and Alecia Mercer met at Jones High School, where he was a year ahead of her. Mercer said Small was kind to her at first, but changed. Her mother said Small didn't want to support his child.
But Katie Small said her brother had a "pretty good relationship" with his son before he left for basic training and he and Mercer went their separate ways.
"He was funny, outgoing," she said. "He was great with children. I have three girls, and he was perfect with them. He was smart. He had a good head on his shoulders. He may have messed around and done some crazy things, but he was an all-around great person, the kind that any girl would take home to momma. He was sweet and loving and just perfect."
And his father said Small's decision to donate his organs was just indicative of his son's character for his whole life.
"If he had it, he would give it to you," the father said. "Anything that somebody wanted all they had to do was ask. And that's just the type of person he was."
Associated Press National Writer A. Breed in Trenton, N.C., and AP Correspondent David Dishneau in Hagerstown, Md., contributed to this story.