A man has died of rabies after receiving a kidney from another man who had died of the disease after being scratched by a skunk.
In a case described as “exceptionally rare” by officials, the Michigan patient received a kidney transplant at an Ohio hospital in December 2024.
He began experiencing alarming symptoms five weeks later, including tremors, lower extremity weakness, confusion, and urinary incontinence.
He was soon hospitalised and ventilated, then died. Postmortem testing confirmed rabies, a report by the Centers for Disease Control and Prevention (CDC) said.
The diagnosis stunned the recipient’s family, who said he had no exposure to animals.
Doctors sought to find the cause and did so by reviewing records about the kidney donor, a man in Idaho, who had disclosed that he was scratched by a skunk in a Donor Risk Assessment Interview (DRAI) questionnaire.
The donor’s family explained that a couple of months earlier, in October, while he was holding a kitten in a shed on his rural property, a skunk approached showing “predatory aggression toward the kitten.”
What followed was an encounter that the report says “rendered the skunk unconscious” as the man fought off the animal.
A man died after receiving a kidney from a man who died of rabies, which he had received from a skunk
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He did not escape unscathed, as he received a “shin scratch that bled,” though he did not think he had been bitten.
Five weeks later, a family member said he became confused and struggled to swallow or walk.
Other symptoms included hallucinations and a stiff neck. He was found unresponsive two days later after a presumed cardiac arrest.
He was resuscitated and hospitalised but never regained consciousness. After several days, he was “declared brain dead and removed from life support,” the report said.
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Lab experiments determined the cause of death
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It added that several of his organs, including his left kidney, were donated.
After rabies was suspected in the kidney recipient, authorities tested laboratory samples from the donor; they tested negative for rabies.
Biopsy samples directly from the kidneys, however, detected a strain “consistent with silver-haired bat rabies,” suggesting that he had actually died of rabies and passed it on to the recipient.
The CDC noted that the risk of any transplant-transmitted infection is very low, and this was only the fourth reported case of its kind in the United States since 1978.
The report stated that in the US, family members often provide information about a prospective donor’s infectious disease risks.
It added that rabies is typically “excluded from routine donor pathogen testing because of its rarity in humans in the United States and the complexity of diagnostic testing.”
“In this case, hospital staff members who treated the donor were initially unaware of the skunk scratch and attributed his pre-admission signs and symptoms to chronic co-morbidities.”