Man Infected with Fatal Rabies from Contaminated Organ Donation

A Tragic Case of Rabies Transmission Through Organ Transplantation

A tragic case of rabies transmission through an organ transplant has been confirmed by health officials, marking a rare and alarming event in the United States. The incident involved a Michigan resident who died from rabies after receiving a transplanted kidney from a donor in Idaho.

The Centers for Disease Control and Prevention (CDC) revealed the case in a recent report, stating that the man received a left kidney from an Idaho-based donor in December 2024. Approximately five weeks after the transplantation, the recipient began experiencing symptoms such as tremors, limb weakness, confusion, and urinary incontinence. A week later, he developed a fever, had difficulty swallowing, was unstable on his feet, and exhibited a fear of water—a classic symptom of rabies.

He was hospitalized, and the CDC was notified. Seven days after hospitalization, the man passed away, and postmortem testing confirmed the presence of rabies. Further analysis revealed that the virus was a strain consistent with the silver-haired bat variant. However, the man's family reported no direct exposure to animals, leading officials to suspect the donor as the source of infection.

During the Donor Risk Assessment Interview (DRAI), the donor had mentioned being scratched by a skunk. Later, the donor's family revealed that he had encountered a skunk on his rural property in Idaho. During an encounter that rendered the skunk unconscious, the man was scratched by the animal and began bleeding. At the time, he told his family he didn't think he had been bitten.

However, five weeks after the incident, the donor himself began exhibiting symptoms such as confusion, difficulty swallowing and walking, hallucinations, and a stiff neck. Two days later, he was found unresponsive at home, resuscitated, and hospitalized but never regained consciousness. He was declared brain dead and removed from life support five days later.

His left kidney, heart, lungs, and both corneas were recovered. After the donor became suspected of being the source of the infection, stored lab samples were tested and initially came back negative for rabies. However, biopsy samples from his kidneys revealed a rabies strain consistent with the silver-haired bat, suggesting organ-derived transmission.

Four grafts from the donor's corneas were planned for transplant. Three patients received them in December 2024 and January 2025. Upon investigation of the rabies case, those grafts were removed from the recipients, and the fourth transplant was canceled. The CDC later detected rabies in one of the previously implanted corneal grafts.

All patients received Post-Exposure Prophylaxis (PEP) to prevent infection with rabies, and no additional cases were reported. The heart and lungs were never transplanted but were used for training purposes in Maryland. By the time of the investigation, no samples remained for rabies testing.

Rabies is a fatal viral disease that affects the central nervous system and is transmitted through the saliva of infected animals such as dogs, raccoons, bats, coyotes, and foxes. It is almost always fatal in humans, with fewer than 20 documented cases of survival. Early symptoms include fever, headache, agitation, confusion, and vomiting. As the infection progresses, patients may experience excessive salivation, hallucinations, difficulty swallowing, and partial paralysis.

While vaccines can be administered after potential exposure to rabies, there is no effective treatment once symptoms appear. Although direct human-to-human transmission of rabies has never been confirmed, it can occur in extremely rare cases involving infected organ or tissue transplantation.

A 2018 study published by the National Institutes of Health (NIH) stated: "Undiagnosed or misdiagnosed rabid donors are the reason for rabies virus transmission via solid organ or tissue allotransplantation." The exact mechanism of how the infection spreads from a contaminated organ to the rest of the body remains unclear.

The most recent CDC report notes this is the fourth reported case of transplant-transmitted rabies in the U.S. since 1978, with the overall risk remaining low. In total, 13 organ recipients have been involved in these four events. Seven who did not receive PEP died, while six who received PEP survived.

Although organs are routinely screened for infectious diseases, cancers, and functionality before transplantation, rabies testing is not typically performed due to its rarity and the time required for test results. On average, around 4,000 animal rabies cases are reported annually, with over 90% occurring in wildlife and fewer than 10 human deaths each year, according to the CDC.