A Michigan man has died of rabies after receiving a kidney transplant from a donor who was scratched by a skunk while defending a kitten, according to a recent report from the Centers for Disease Control and Prevention (CDC). The incident, described by officials as an “exceptionally rare event”, marks only the fourth reported transplant-transmitted rabies case in the United States since 1978.
The recipient underwent a kidney transplant at an Ohio hospital in December 2024. Approximately five weeks later, he developed tremors, lower extremity weakness, confusion and urinary incontinence. He was hospitalised, placed on a ventilator, and subsequently died. Postmortem testing confirmed rabies, puzzling authorities as the patient’s family reported no animal exposure.
Investigators reviewed the donor’s medical records and discovered that during the Donor Risk Assessment Interview, the donor mentioned being scratched by a skunk. The donor’s family explained that in October, while holding a kitten in a shed, a skunk approached with “predatory aggression”. The donor fought off the animal, rendering it unconscious, but sustained a bleeding shin scratch. He did not believe he had been bitten.
Five weeks later, the donor became confused, experienced difficulty swallowing and walking, hallucinations, and a stiff neck. Two days after that, he was found unresponsive at home following a presumed cardiac arrest. He was resuscitated and hospitalised but never regained consciousness; he was declared brain dead and removed from life support. Several organs, including his left kidney, were donated.
Initial laboratory samples from the donor tested negative for rabies, but biopsy samples from his kidneys detected a strain “consistent with a silver-haired bat rabies”. The investigation suggested a “likely three-step transmission chain”: a bat infected a skunk, which infected the donor, whose kidney then infected the recipient. Three other 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 pathogen testing due to its rarity in humans in the US and the complexity of diagnostic testing. Hospital staff treating the donor were initially unaware of the skunk scratch and attributed his symptoms to chronic co-morbidities. Dr Lara Danziger-Isakov of Cincinnati Children’s Hospital Medical Center described the event as “exceptionally rare”, adding that “overall, the risk is exceptionally small”.
