In January 2025, a Michigan man died of rabies only weeks after receiving a kidney transplant at an Ohio hospital; investigators later traced the infection to a donated kidney from an Idaho man who had been scratched by a skunk in late October 2024. The donor was found unresponsive in early December 2024 and, despite a negative stored serum for rabies antibodies, an archived kidney biopsy tested positive for rabies virus RNA. The Centers for Disease Control and Prevention (CDC) says this is the fourth documented instance in the United States of rabies transmission through transplanted organs since 1978 and urges stronger donor risk assessment and public-health consultation. More than 350 potential contacts were assessed and 46 people were advised to receive post-exposure prophylaxis (PEP) to avert further cases.
Key Takeaways
- This incident occurred after a kidney transplant in Ohio; the recipient developed symptoms about five weeks after surgery and died in January 2025 on the seventh day of hospitalization.
- The donor, an Idaho resident, had been scratched by a skunk in late October 2024 and was found unresponsive in early December 2024; organs were recovered for transplantation before rabies was suspected.
- Archived testing found rabies virus RNA in a biopsy of the donated kidney despite a stored donor serum testing negative for rabies antibodies.
- The CDC characterizes this as the fourth US organ-transmitted rabies case since 1978, underlining the rarity but extreme lethality of such events.
- Public-health authorities evaluated 357 possible contacts of the donor and recipient; 46 people, including healthcare workers and cornea recipients, were advised to receive PEP consisting of human rabies immune globulin and vaccine.
- Three cornea recipients had grafts removed and were given PEP as a precaution; the donor’s heart and lungs were used for training at a Maryland research facility and were not considered a risk to trainees.
- The case exposed gaps in current donor screening: rabies testing on organs is not routine and a documented animal exposure was not recognized as a reason to delay transplantation.
Background
Rabies is a viral disease usually transmitted through the saliva of infected mammals, most commonly via bites or scratches. Once clinical symptoms appear, rabies is almost always fatal; fewer than 50 survivors have been documented globally despite aggressive therapy in rare cases. In much of the world, dog bites remain the leading source of human rabies, while in the United States transmission more commonly involves wildlife such as bats, raccoons and skunks.
Organ transplantation saves lives but also raises difficult screening questions because donors may be acutely ill and evaluation time is limited. Current donation protocols rely heavily on medical records and risk-assessment interviews; routine virologic testing of organs for rare pathogens such as rabies is not standard practice. That gap can create a trade-off between maximizing organ availability and minimizing the risk of transmitting uncommon but lethal infections.
Main Event
According to CDC investigators, the Idaho donor sustained a skunk scratch in late October 2024 and was found unresponsive about five weeks later in early December 2024; his death was attributed initially to presumed cardiac arrest. Because rabies was not suspected, his organs — including heart, lungs, left kidney and corneas — were recovered and allocated to recipients. The kidney was transplanted into a Michigan patient who began showing signs consistent with rabies roughly five weeks after the transplant.
Clinicians caring for the Michigan recipient sent saliva, skin and other specimens to the CDC, which detected rabies virus RNA in some samples. Given the recipient’s lack of documented animal exposure, investigators reexamined the donor’s samples: stored serum from the Idaho donor tested negative for rabies antibodies but an archived kidney biopsy was positive for rabies RNA, implicating the transplanted organ as the infection source.
The Michigan patient died on the seventh day after hospitalization. Following confirmation of donor-derived rabies, authorities acted to limit further transmission: three cornea recipients had their grafts removed and were given PEP, and health departments performed contact tracing that identified 357 possible exposures, of which 46 individuals were advised to receive PEP.
Analysis & Implications
The case highlights a persistent vulnerability in transplant safety: uncommon exposures documented in donor interviews can be overlooked if clinical signs are not recognized as compatible with rare infections. Rabies can incubate for weeks to months, which complicates rapid assessment; a recent animal bite or scratch, particularly in a donor with acute encephalopathy, should prompt heightened evaluation and public-health consultation.
Implementing routine virologic screening for rabies in all donors is likely impractical and would further constrain an already scarce organ pool, but targeted testing when donors report exposure to rabies-susceptible animals or show unexplained neurologic decline could reduce the risk of donor-derived transmission. The CDC recommends that transplant teams consult public-health officials for donors with such histories to determine appropriate testing and management.
For recipients and other contacts, PEP remains the critical preventive measure when exposure is suspected prior to symptom onset. The prompt removal of corneal grafts and delivery of PEP likely reduced the chance of further cases in this cluster; however, once clinical rabies develops, therapeutic options are extremely limited. Policymakers must balance the lifesaving benefits of transplantation against rare but catastrophic infectious risks and consider clearer guidance and rapid-response pathways for suspected donor-derived infections.
Comparison & Data
| Metric | Value |
|---|---|
| US organ-transmitted rabies cases since 1978 | 4 (including this case) |
| Potential contacts assessed | 357 |
| People advised to receive PEP | 46 |
| Cornea recipients affected | 3 (grafts removed; PEP given) |
| Donor animal exposure documented | Skunk scratch in late Oct 2024 |
While organ-derived rabies transmission is exceptionally rare in the U.S., the high case fatality rate makes each event consequential. The numerical scale here — dozens evaluated and dozens given prophylaxis — illustrates the public-health ripple effect from a single unrecognized donor infection.
Reactions & Quotes
“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.”
CDC, MMWR 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.”
CDC, MMWR report
Public-health officials and transplant centers described the case as a catalyst for reviewing screening and communication protocols; transplant teams face pressure to shorten evaluation times while ensuring rare but deadly risks are not missed. Community reaction has focused on appreciation for the rapid public-health response and concern over how to prevent similar events without needlessly discarding viable organs.
Unconfirmed
- Whether rabies virus was present in other donated tissues (beyond the kidney biopsy) at levels capable of causing infection is not fully established.
- The precise timeline of donor viral replication and whether the donor had circulating virus at organ recovery remains uncertain despite detection of viral RNA in the kidney biopsy.
- It is not yet confirmed whether any additional recipients beyond the known cornea patients and the kidney recipient have evidence of infection.
Bottom Line
This rare but deadly event shows that a single unrecognized animal exposure in a donor can trigger a large and urgent public-health response and, tragically, a fatal outcome for a transplant recipient. The incident underscores the need for clearer, actionable guidance for transplant teams when donors have recent exposures to rabies-susceptible animals or unexplained neurologic symptoms.
Targeted changes — such as mandatory public-health consultation for donors with potential rabies exposures, rapid access to molecular testing on archived tissues, and predefined protocols for recipient risk assessment and PEP — could reduce the chance of future donor-derived rabies without unduly restricting the organ supply. Transparency about what is confirmed and what remains uncertain will be essential as policies are reviewed and updated.