A Michigan man has died of rabies after receiving a kidney transplant from a donor who had been scratched by a skunk while defending a kitten, according to a report from the US Centers for Disease Control and Prevention (CDC). The case is described as an 'exceptionally rare event'.
The recipient underwent a kidney transplant at an Ohio hospital in December 2024. About five weeks later, he developed tremors, lower extremity weakness, confusion and urinary incontinence. He was hospitalised, placed on a ventilator and died. Postmortem testing confirmed rabies, which puzzled doctors because the patient had no known animal exposure.
Investigators reviewed the donor's records and discovered that in a risk assessment questionnaire, he had reported being scratched by a skunk. The donor's family explained that in October 2024, while holding a kitten in a shed, a skunk approached with 'predatory aggression'. The man fought off the skunk, rendering it unconscious, but sustained a shin scratch that bled. He did not think he had been bitten.
Five weeks later, the donor became confused, had difficulty swallowing and walking, experienced hallucinations and a stiff neck. Two days later, he was found unresponsive at home after a presumed cardiac arrest. He was resuscitated but never regained consciousness and was declared brain dead. His left kidney and other organs were donated.
Initial laboratory samples from the donor tested negative for rabies, but biopsy samples from his kidneys detected a strain consistent with silver-haired bat rabies. The CDC concluded a likely three-step transmission chain: a bat infected a skunk, which infected the donor, whose kidney then infected the recipient. This is only the fourth reported transplant-transmitted rabies event in the US since 1978.
Three people who received cornea grafts from the same donor had the grafts removed and received post-exposure prophylaxis; they remain asymptomatic. The CDC noted that rabies is typically excluded from routine donor testing due to its rarity in humans and the complexity of diagnostic testing. Hospital staff were initially unaware of the skunk scratch, attributing the donor's symptoms to chronic conditions.
