Health officials in the United States have confirmed a rare and tragic case of rabies transmitted through an organ transplant, resulting in the death of a Michigan resident. The Centres for Disease Control and Prevention (CDC) detailed the incident in a report published on Thursday, highlighting the critical risks associated with undiagnosed infections in donors.
A Fatal Chain of Events
The case began in December 2024 when the Michigan man received a left kidney from a donor in Idaho. Roughly five weeks after the transplant surgery, the recipient began to experience alarming symptoms, including tremors, limb weakness, confusion, and urinary incontinence. His condition deteriorated rapidly within a week, presenting with fever, difficulty swallowing, instability, and a classic symptom of rabies: a fear of water, known as hydrophobia.
He was immediately hospitalised and the CDC was notified. Despite medical intervention, the organ recipient died just seven days after being admitted. Postmortem testing confirmed the cause of death as rabies. Further analysis identified the specific strain as one consistent with the silver-haired bat variant. However, the man's family insisted he had no known exposure to animals, prompting investigators to look to the organ donor as the potential source.
The Donor's Undiagnosed Infection
The investigation revealed a critical oversight. Prior to the donation, a standard Donor Risk Assessment Interview (DRAI) questionnaire noted that the donor had been scratched by a skunk. Following the recipient's death, the donor's family provided more detail: the donor, who lived on a rural property in Idaho, had an encounter with a skunk that left the animal unconscious. During this incident, the man was scratched and began bleeding, but he assured his family at the time that he did not believe he had been bitten.
Approximately five weeks after the skunk encounter, the donor himself developed severe symptoms, including confusion, difficulty swallowing and walking, hallucinations, and a stiff neck. Two days later, he was found unresponsive at home. Although resuscitated and hospitalised, he never regained consciousness. He was declared brain dead and removed from life support five days later. His organs, including the left kidney, heart, lungs, and both corneas, were recovered for transplantation.
Investigation and Wider Implications
When the donor became the suspected rabies source, stored lab samples were tested but returned negative. However, a breakthrough came when biopsy samples from his kidneys were examined. The CDC detected the silver-haired bat rabies strain in his right kidney, strongly suggesting organ-derived transmission.
The incident triggered a wider safety review. Four corneal grafts from the donor were planned for transplant. Three patients received them in December 2024 and January 2025. Upon investigation, those grafts were surgically removed from the recipients and a fourth planned transplant was cancelled. The CDC later detected rabies in one of the implanted corneal grafts. All affected patients received Post-Exposure Prophylaxis (PEP) to prevent infection, and no further cases were reported.
The donor's heart and lungs were never transplanted but were used for training purposes in Maryland. By the time of the investigation, no samples from these organs remained for rabies testing.
This marks the fourth reported case of transplant-transmitted rabies in the US since 1978. In total, across these four events, 13 organ recipients were involved. Seven who did not receive PEP died, while six who did receive the preventative treatment survived. While organs undergo rigorous screening for many diseases, routine rabies testing is not standard practice due to the rarity of the infection and the time required for test results.
Rabies is an almost invariably fatal viral disease attacking the central nervous system, transmitted through the saliva of infected animals. Once symptoms appear, there is no effective treatment. This tragic case underscores the persistent, albeit low, risks in organ transplantation and the vital importance of thorough donor history assessments.
