A Michigan man died of rabies after receiving a kidney transplant from another man who was infected by the disease when a skunk scratched him, federal health officials said in a new report.
The Michigan patient died in January after getting a kidney transplant from an Idaho donor in December 2024, according to aCenters for Disease Control and Prevention reportreleased last week. Postmortem testing confirmed that the patient had contracted rabies, but the CDC said interviews with his family revealed that he did not have any exposure to animals.
"(The) diagnosis of rabies in a kidney transplant recipient with no recognized animal exposure resulted in a multistate public health investigation to ascertain whether the kidney donor had undiagnosed rabies, identify other donor organs and tissues, and identify rabies-exposed persons," according to the CDC.
The investigation identified kidney biopsy samples in which the CDC detected rabies virus RNA consistent with a silver-haired bat rabies virus variant, the report states.
In later interviews with the donor's family members, the CDC said investigators discovered the person had been scratched by a skunk weeks before their death while protecting a kitten and had exhibited rabies-like symptoms before their death. The CDC believes a bat bit the skunk, which then scratched the donor.
The case is believed to be the "fourth transplant-transmitted rabies event in the United States since 1978," according to the CDC. Previous cases resulted in 13 infections and seven deaths. Rabies is almost always fatal without prompt treatment.
When did the kidney recipient die?
The Michigan patient received a left kidney transplant from the donor at an Ohio hospital in December 2024, according to the CDC.
About five weeks later, the agency said the transplant recipient experienced tremors, lower extremity weakness, confusion, and urinary incontinence. Seven days after symptom onset, the recipient was hospitalized with fever, hydrophobia, dysphagia, and autonomic instability.
On the second day of being hospitalized, the CDC said the recipient required invasive mechanical ventilation. He then died five days later.
Various samples were sent to the CDC for testing, and the recipient was found to have rabies virus RNA in their saliva, skin, and brain tissue samples, according to the report.
The CDC had previouslyreported in Februarythat a patient had died in Ohio after getting a transplanted kidney from a donor with undiagnosed rabies. At the time, the agency did not provide further details about the recipient or donor.
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How did the donor get rabies?
The donor was an Idaho resident, according to the CDC. Following the transplant recipient's death, the agency said interviews with the donor's family revealed information not previously disclosed.
The donor's family told investigators that in late October 2024, the donor was approached by a skunk while holding a kitten in an outbuilding on his rural property, according to the CDC.
"During an encounter that rendered the skunk unconscious, the donor sustained a shin scratch that bled, but he did not think he had been bitten," the agency said. "According to the family, the donor attributed the skunk's behavior to predatory aggression toward the kitten."
A family member said that about five weeks later, the donor became confused, had difficulty swallowing and walking, experienced hallucinations, and had a stiff neck, according to the CDC. Two days after reporting those symptoms, he was found unresponsive at home after a "presumed cardiac arrest," the agency said.
The donor was "resuscitated and hospitalized but never regained consciousness," according to the CDC. He was later declared brain dead and was removed from life support. His left kidney, heart, lungs, and both corneas were recovered.
Why wasn't the donor screened for rabies?
Rabies is excluded from routine donor pathogen testing because of its rarity in humans in the United States and the complexity of diagnostic testing, the CDC said.
In the United States, potential donors' family members often provide information about a donor's infectious disease risk factors, including animal exposures. In this case, hospital staff members who treated the donor were initially unaware of the skunk scratch, according to the CDC.
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Did anyone else receive infected organs?
According to the CDC, no other organs were transplanted but four cornea grafts were prepared. Three patients, one each from California, Idaho, and New Mexico, received grafts in December 2024 and January 2025.
The cornea recipients underwent precautionary graft removal and received rabies treatment, the agency said. A fourth corneal graft that was planned for a Missouri patient was cancelled.
The heart and lungs of the donor were not transplanted, but were used in training procedures at a Maryland medical research facility, according to the agency. None remained for testing by the time of the discovery.
In addition, 370 health care workers and others exposed to either the kidney donor or recipient were interviewed, and 46 underwent rabies treatment as a precaution, the CDC said.
What is rabies?
Rabies is a fatal but preventable viral disease that primarily affects the central nervous system,according to the CDC. It can lead to severe brain damage and death in humans and some animals.
Rabies is often found in bats, raccoons, skunks, and foxes, but any mammal can be infected. Pets and people can be protected byvaccination. People usually receive the vaccine after exposure, but those in high-risk situations may receive it before exposure.
Human cases are rare in the United States, where fewer than 10 deaths are reported each year, and at least 7 out of 10 of those are theresult of exposure to an infected bat.
Contributing: Mary Walrath-Holdridge, USA TODAY
This article originally appeared on Lansing State Journal:Kidney recipient dies from an organ infected with rabies: CDC report
A Michigan man died of rabies after receiving a kidney transplant from another man who was infected by the disease when a...
