A recipient of a kidney transplant presented a medical mystery when he died from rabies in January 2025 only weeks after his surgery in an Ohio hospital, despite having had no documented contact with the disease.
A close investigation by the CDC revealed the cause: The Michigan man's donor kidney was infected by the deadly virus – only the fourth time rabies has been transmitted via transplanted organs in the US since 1978.
The case, the CDC says, highlights the need for stronger guidance for transplant teams where the donor has a history of exposure to animals.
Related: Rabies Is a Deadly, Unpredictable Threat. Here's How to Protect Yourself.
Rabies is a viral pathogen that spreads typically via the saliva of infected animals, usually through bites or scratches. Capable of infecting all mammals, including humans, the disease is almost always fatal once symptoms appear; fewer than 50 cases of survival have been documented worldwide, with medical specialists rarely succeeding in keeping patients alive despite extreme measures.
Globally, transmission most often occurs from dog bites, but any infected mammal can transmit the disease. The donor in this case, an Idaho man, had been found unresponsive after a presumed cardiac arrest in early December 2024, around five weeks after being scratched by a skunk in late October.
No one suspected the involvement of rabies at the time. So as the man was an organ donor, his heart, lungs, left kidney, and corneas were removed.
Around five weeks after receiving the kidney, the Michigan patient developed symptoms consistent with rabies. Doctors sent samples of his saliva, skin, and other fluids to the CDC, which detected rabies virus RNA in some of the samples.
Because the recipient had no history of animal exposure, investigators turned back to the donor. A stored serum sample from the Idaho man tested negative for rabies antibodies, but an archived biopsy of his kidney was positive for rabies virus RNA, confirming the organ as the source of infection.
The Michigan recipient died on the seventh day after hospitalization, but he may have saved other lives. The donor's heart and lungs were used for training at a Maryland research facility and did not pose a risk, but three other patients had received corneal grafts from the donor's corneas.
Doctors immediately removed the transplanted corneas and prescribed the patients a course of highly effective Post-exposure Prophylaxis, or PEP – human rabies antibodies plus a vaccine given before symptoms appear.
Public health officials assessed 357 possible contacts of both the donor and the kidney recipient. In total, 46 people – including healthcare workers, community contacts, and the cornea recipients – were advised to receive PEP.
The sequence of events highlights a vulnerability in the current donor system. While the donor's risk assessment interview documented the skunk scratch, his symptoms hadn't been recognized as consistent with rabies, so his skunk encounter wasn't raised as a testable rabies risk until after the kidney recipient had died as well.
Since rabies testing on donor organs is not routine, and no one raised any red flags, the transplants took place as scheduled.
Rabies can take weeks to months to become symptomatic after transmission. The CDC advises significantly more caution with donors who have had a potential exposure.
"If a potential donor, particularly one with acute encephalopathy, had a bite or scratch from a rabies-susceptible animal during the preceding year, transplant teams should consider consulting public health officials to determine rabies risk," the organization writes in its report.
"If an organ or tissue has been transplanted from a donor who is subsequently suspected to have had rabies, a risk assessment could save lives by accelerating diagnostic testing, possible explantation when deemed clinically appropriate, and PEP administration to recipients and other contacts."
For more detail, see the CDC's Morbidity and Mortality Weekly Report.