Man dies of rabies after kidney transplant from donor who unknowingly had disease, CDC says

LANSING, Mich. (WILX/Gray News) — A Michigan man died of rabies months after receiving a transplanted kidney from someone who unknowingly had contracted the disease from a skunk, according to a report from the Centers for Disease Control and Prevention.

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In a report released last week, the CDC said a Michigan man received a kidney from an Idaho donor at a hospital in Ohio in December 2024.

About five weeks later, the recipient began experiencing tremors, lower extremity weakness, confusion and urinary incontinence, according to the report.

A week after symptom onset, the man was hospitalized with fever, hydrophobia (fear of water, a symptom of rabies), difficulty swallowing and autonomic instability. On the second day of hospitalization, he was placed on a ventilator.

Two days later, hospital staff contacted the Ohio Department of Health and the CDC because the man’s signs and symptoms were compatible with rabies.

The man died after seven days in the hospital, according to the CDC. Findings from an autopsy determined he was infected with rabies. Officials have not released his identity.

After doctors began suspecting rabies in the transplant recipient, officials began investigating the Idaho donor as the possible infection source.

Interviews with the donor’s family added details that were not initially revealed in the Donor Risk Assessment Interview questionnaire.

“In late October 2024, a skunk approached the donor as he held a kitten in an outbuilding on his rural property. 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 CDC’s report said. “According to the family, the donor attributed the skunk’s behavior to predatory aggression toward the kitten. A member of the donor’s household reported that approximately five weeks later, in early December, the donor was confused, had difficulty swallowing and walking, experienced hallucinations, and had a stiff neck.”

Two days after the donor began experiencing those symptoms, he was found unresponsive at home from presumed cardiac arrest, according to the CDC report. He was resuscitated and hospitalized but never regained consciousness. He was declared brain dead and removed from life support on his fifth day in the hospital. His left kidney, heart, lungs and both corneas were recovered.

After rabies was suspected in the kidney recipient, stored serum that had been collected from the donor on his third hospital day was tested and determined to be negative for rabies virus antibody, according to the CDC. A multiweek laboratory traceback investigation identified right and left kidney biopsy samples. The CDC detected rabies virus RNA consistent with a silver-haired bat rabies virus variant in a biopsy sample of the right kidney, suggesting organ-derived transmission. The left kidney biopsy sample had insufficient tissue for testing.

While no other organs from the Idaho donor were transplanted, three people received cornea tissue grafts. The CDC said that, while investigation of the donor’s rabies status was ongoing, the cornea recipients underwent precautionary graft removal and received the rabies vaccine, postexposure prophylaxis (PEP). Rabies is almost always fatal without timely receipt of PEP, according to the CDC.

None of the people who received cornea tissue grafts have developed signs or symptoms compatible with rabies.

A CDC investigation identified 370 people with possible exposures to the donor or kidney recipient. Among those who completed risk assessments, 46 people were recommended to receive the rabies vaccine.

Although the rabies virus is typically transmitted through animal bites or scratches, human-to-human transmission has occurred through organ and tissue transplantation before. From 1978 to 2013, three transplant-transmitted rabies events in the United States affected nine tissue or organ recipients, according to the CDC report.