Fatal Rabies Transmission Through Kidney Transplant: Rare Case Highlights Organ Donation Risks

The transplant procedure was conducted at a hospital in Ohio in December 2024. (Representational image)

According to the Centers for Disease Control and Prevention (CDC), a man from Michigan has died from rabies after receiving a kidney transplant from a donor infected with the virus.

The organ transplantation took place at a hospital in Ohio in December 2024. The donor, a man from Idaho, had been scratched on his shin by a skunk that was displaying "predatory aggression" toward a kitten on his property in October 2024.

The CDC report indicates that five weeks following the incident, the donor began experiencing hallucinations, difficulty walking and swallowing, and neck stiffness. Two days later, he collapsed and was rushed to a hospital where medical staff briefly revived him before declaring him brain-dead. When his organs were donated, his family informed doctors about the skunk scratch.

Approximately five weeks after the kidney transplant, the Michigan recipient began experiencing symptoms including tremors, weakness, confusion, urinary incontinence, and swallowing difficulties, along with hydrophobia, a key indicator of rabies. His condition deteriorated rapidly. After a week in the hospital, he passed away. Post-mortem testing confirmed the presence of rabies.

Rabies is a viral disease that impacts the brain and nervous system of mammals, including humans.

"This is an exceptionally rare event," stated Dr. Lara Danziger-Isakov, who leads immunocompromised host infectious diseases at Cincinnati Children's Hospital Medical Center, in an interview with The NY Times. "Overall, the risk is exceptionally small."

Investigators later reviewed the donor's medical records. Hospital personnel were initially unaware of the skunk scratch and attributed the donor's symptoms to chronic medical conditions. The CDC noted that organ donations are not routinely screened for rabies due to the rarity of human cases and the complexity of testing. Donors undergo screening for HIV and several types of hepatitis, but not for rabies.

Medical professionals re-examined biopsies from both of the donor's kidneys that were taken before the transplant. The unused kidney tested positive for rabies. Doctors were unable to test the transplanted kidney. Testing revealed that both the donor and recipient were infected with a rabies strain associated with bats.

The donor's corneas were transplanted into three patients. After the rabies diagnosis, doctors removed the corneal grafts and administered preventive treatment to all three recipients. One graft tested positive for rabies, but none of the patients displayed symptoms.

Since 1978, only four organ donors in the United States have transmitted rabies to a total of 13 recipients. Six recipients survived after receiving treatment, while seven died.