A man passed away from rabies following a kidney transplant from a donor who likely contracted the virus after being scratched by a skunk. This unusual transmission chain was documented in a report by the Centers for Disease Control and Prevention (CDC), marking only the fourth case of transplant-transmitted rabies in the United States in the last 50 years. The individual received the transplant at an Ohio medical facility in December 2024.
Symptoms including tremors, weakness, confusion, and urinary incontinence appeared five weeks post-transplant, leading to urgent medical evaluation. Subsequently, the patient was hospitalized with a fever and rapidly deteriorated, necessitating ventilation and ultimately resulting in death.
Postmortem tests revealed the presence of the virus in the patient’s saliva and brain tissue. Despite the patient’s lack of animal contact, investigators turned their focus to the organ donor, a man from Idaho who had succumbed to rabies after being scratched by a skunk on his rural property.
The donor had disclosed the skunk scratch incident during the Donor Risk Assessment Interview. Family members explained that he had defended a kitten from the skunk, rendering the animal unconscious but sustaining a bleeding shin scratch in the process. Approximately five weeks later, the donor exhibited confusion, hallucinations, swallowing and walking difficulties, and a stiff neck before his untimely demise.
Laboratory screenings on the donor initially failed to detect rabies. However, after the transplant recipient fell ill, further tests on preserved samples revealed the presence of the virus in biopsy material extracted directly from the kidneys.
Investigations determined that the donor had died from rabies and transmitted the virus through the transplanted kidney. The transmission chain was believed to involve a bat infecting a skunk, the skunk infecting the donor, and the donor’s kidney infecting the transplant recipient.
The rarity of such a cause of death was highlighted, given the low incidence of rabies in humans in the United States and the complex diagnostics required for detection. The CDC stressed the minimal risk of transplant-transmitted infections like rabies, emphasizing that this event was only the fourth of its kind since 1978.
Following the discovery, authorities identified and monitored recipients of other tissues from the donor, such as cornea grafts, and provided Post-Exposure Prophylaxis as a precaution. Thankfully, the three individuals who received the cornea grafts remained asymptomatic.
The CDC pointed out that organ donor risk assessments often rely on family reports of potential exposures to infected animals due to the infrequent screening for rabies during donor testing. Rabies is typically excluded from routine pathogen testing due to its rarity in humans in the U.S. and the complexities of diagnostic procedures.
Dr. Lara Danziger-Isakov, from Cincinnati Children’s Hospital Medical Centre, described the incident as exceedingly rare, emphasizing the overall minimal risk associated with such occurrences.