A man infected with rabies had his organs donated to four people – already killing one.
In December 2024, a Michigan patient received a kidney transplant from an Idaho donor at an Ohio hospital, according to a Centers for Disease Control and Prevention (CDC) report.
Around five weeks after the procedure, he began experiencing tremors, weak legs, confusion and urinary incontinence.
Seven days later, he was hospitalised with a fever, an irrational fear of water, swallowing difficulties and involuntary functions.
He needed invasive ventilation and was showing signs of rabies.
On his seventh day in hospital, the man died and his post-mortem tests confirmed he had contracted rabies.
An investigation into the kidney donor found that he was scratched by a skunk in late October 2024.
The donor’s family said that the skunk had approached him, showing ‘predatory aggression’ towards a kitten he was stood holding in a shed.
While fighting off the animal in an encounter that the report says left the animal ‘unconscious’, the donor received a ‘shin scratch that bled.’
He did not think he had been bitten.
What is Rabies?
Rabies is a rare but serious infection that is usually caught from a bite or scratch of an infected animal.
You can also get rabies if an infected animal licks your eyes, nose, mouth or wound.
Symptoms include: numbness or tingling where you were bitten or scratched, hallucinations, anxious or energetic feelings, difficulty swallowing or breathing and paralysis.
Once symptoms appear, it is almost always fatal, but vaccination and early treatment can prevent it.
Rabies is very rare in the UK and more common in parts of Africa, Asia, Central and South America.
It is spread by mammals such as dogs, bats, raccoons and foxes.
Treatment usually involves two or more doses of the rabies vaccine and a medicine.
Source: NHS
Five weeks later, in early December, the donor was confused, had difficulty swallowing and walking, experienced hallucinations and had a stiff neck, a family member reported.
Two days after his symptoms began, he was found unresponsive at home after a presumed cardiac arrest.
Despite resuscitation, he did not regain consciousness and was declared brain dead a few days later.
It was found that the donor had disclosed he was scratched by a skunk in a Donor Risk Assessment Interview (DRAI).
Although laboratory samples from the donor came back negative for rabies, biopsy samples directly from the kidney detected a strain ‘consistent with a silver-haired bat rabies’.
The investigation suggested a likely ‘three-step transmission chain’ where a rabid silver-haired bat infected a skunk, which then infected the donor and then the recipient of the organ donation.
Three other people were identified as having cornea grafts from the infected donor.
Authorities immediately removed these patients’ grafts and were given a treatment to prevent infection.
The report said they remain asymptomatic.
This case is the fourth reported transplant-transmitted rabies event in the United States since 1978, the CDC said in the report.
Typically, the risk for any infection to be transmitted through transplant, including rabies, is extremely low.
The report stated that in the United States, ‘rabies is excluded from routine donor pathogen testing because of its rarity in humans’ in the country and the ‘complexity of diagnostic testing’.
To identify interventions that could be put in place to further reduce rabies risk in transplants, the CDC and others are reviewing reported incidents.
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