Rabies kills recipient of kidney transplant from donor infected by rabid skunk

A Michigan man died of rabies in January after receiving a kidney transplant from someone infected with the disease.

The case was only the fourth time rabies has been transmitted to a person via organ transplant in the U.S. since 1978, the Centers for Disease Control and Prevention said.

The man received a left kidney from a deceased donor from Idaho at an Ohio hospital in December 2024. He began to suffer rabies symptoms about five weeks later.

He had tremors, weak lower extremities, confusion and incontinence. A week after those symptoms began, he was hospitalized with fever, hydrophobia, autonomic instability and difficulty swallowing. By his second day in the hospital, he required invasive ventilation, and by day four, doctors figured out that the symptoms could be from rabies.

After a week in the hospital, the kidney recipient died, 51 days after receiving the kidney. Shortly thereafter, officials confirmed he had rabies. His family told Michigan public health officials that he had not been exposed to any possibly rabid animals, the CDC said.

Rabies is not included in normal pathogen testing for donors because of its “rarity in humans in the United States and the complexity of diagnostic testing. In this case, hospital staff members who treated the donor were initially unaware of the skunk scratch and attributed his preadmission signs and symptoms to chronic comorbidities,” the CDC said.

The donor risk assessment questionnaire did, however, note that the person in Idaho who donated the kidney had been scratched by a skunk. Upon further questioning, the donor’s family told Idaho health officials and the CDC that he had been scratched by the skunk after the animal displayed predatory aggression toward a kitten on his rural property.

Much like the eventual recipient of his left kidney, the Idaho donor started exhibiting symptoms about five weeks after the scratch, suffering from a stiff neck, hallucinations, difficulty swallowing and difficulty walking before having a presumed cardiac arrest. He was hospitalized but never regained consciousness and was taken off life support after five days, the CDC said.

Once officials started suspecting that he had had rabies at the time of his death, they found rabies virus RNA in a sample taken from the donor’s right kidney. After this was confirmed, three recipients of cornea grafts from the donor, one each in California, Idaho and New Mexico, got their grafts removed and received postexposure prophylaxis to prevent them from contracting rabies.

In addition, 357 people who could have been exposed to the donor or recipient underwent risk assessments, and 46 of them were also recommended to get postexposure prophylaxis as a preventative measure, the CDC said.