December 9, 2025: Federal health officials have confirmed a rare case of transplant-transmitted rabies resulting in two deaths, one of the donor and the other of the recipient. The findings were published in the U.S. Centers for Disease Control and Prevention (CDC) & Morbidity and Mortality Weekly Report (MMWR).
Transplant-transmitted rabies is extremely rare but highlights gaps in donor history reporting, wildlife exposure awareness, and timely recognition of unusual neurologic symptoms.
Rabies is almost always fatal once symptoms appear, which is why post-exposure prophylaxis must be administered before symptom onset.
Organ donors are rarely tested for rabies because diagnostic testing requires brain tissue and is not feasible for routine screening.
In late October 2024, an Idaho man was scratched on the shin by a skunk while holding a kitten on his rural property. The scratch bled, but the donor did not consider it a bite and did not seek medical attention.
About five weeks later, in early December 2024, the man developed severe symptoms including confusion, difficulty swallowing and walking, hallucinations, and a stiff neck. Two days after symptom onset, he was found unresponsive at home following presumed cardiac arrest. Although resuscitated and hospitalized, he never regained consciousness and was declared brain dead in hospital on 5th day.
His organs including his left kidney, heart, lungs, and both corneas were recovered for donation.
Later, in December 2024, an adult male Michigan resident received the donor’s left kidney at an Ohio hospital. Approximately five weeks later, he developed tremors, lower extremity weakness, confusion, and urinary incontinence.
Seven days after symptom onset, he was hospitalized with fever, hydrophobia (fear of water), dysphagia (difficulty swallowing), and autonomic instability.
By 2nd day of the hospitalization, he required mechanical ventilation. After consulting the Ohio Department of Health and CDC on day 4, samples were collected for rabies testing.
On the 7th day, the recipient died. CDC testing confirmed rabies virus RNA in saliva, nuchal skin, and brain tissue, identifying the silver-haired bat rabies virus variant.
According to NHS, Rabies is a rare but serious infection that's usually caught from a bite or scratch of an infected animal. It's almost always fatal once symptoms appear, but vaccination and early treatment can prevent it.
CDC detected rabies virus RNA consistent with the silver-haired bat variant in a biopsy sample of the donor’s right kidney, confirming organ-derived transmission. Both donor and recipient were infected with the same bat-linked strain.
Investigators traced the chain of transmission: a rabid silver-haired bat infected a skunk, which scratched the donor, ultimately leading to infection of the kidney recipient.
The donor’s heart and lungs were not transplanted but used in training procedures at a Maryland medical research facility. By the time of the public health investigation, no specimens were available for testing.
Contact tracing identified 370 people with potential exposure to the donor or kidney recipient. Of these, 357 (96%) completed risk assessments, and 46 (13%) were recommended for post-exposure prophylaxis (PEP).
Exposed to donor:
4 community contacts: all received PEP
80 health care workers: 17 (21%) received PEP
3 cornea recipients: received PEP and antibody testing
Exposed to kidney recipient:
14 community contacts: 6 received PEP
269 health care workers: 256 (95%) completed risk assessments, 16 (6%) received PEP
This marks the fourth transplant-transmitted rabies event in the U.S. since 1978, previously affecting nine tissue or organ recipients.
Among 13 recipients across all four events, seven who did not receive PEP died, while all six who received PEP survived. Globally, only two PEP failures have been reported among 21 organ or tissue recipients.
Organ donors are not routinely screened for rabies due to the rarity of human infections and the complexity of testing. Experts emphasize that the overall risk for transplant-transmitted infections, including rabies, remains very low.
“This is an exceptionally rare event,” said Dr. Lara Danziger-Isakov, board member of the American Society of Transplantation, told The New York Times. “Overall, the risk is exceptionally small.”
(Rh/VK/MSM)
