A tragic incident occurred where a man passed away from rabies following a kidney transplant from a donor who likely got infected after being scratched by a skunk. This rare case was reported by the Centers for Disease Control and Prevention (CDC), marking only the fourth known instance of rabies transmission through transplantation in the United States in the past 50 years. The transplant took place at an Ohio hospital in December 2024.
Shortly after the transplant, the recipient started exhibiting symptoms such as tremors, weakness, confusion, and urinary incontinence, leading to hospitalization and rapid deterioration. Despite medical efforts, the patient eventually succumbed to the disease. The virus was detected in his saliva and brain tissues. Investigations revealed that the donor, who had passed away in Idaho, had a history of a scratch from a skunk on his property before his demise.
The donor had disclosed the skunk scratch incident during the donor risk assessment interview. The man had encountered the skunk while holding a kitten and had fought off the animal, sustaining a scratch on his shin. Subsequently, he experienced symptoms like confusion, hallucinations, difficulty swallowing and walking, and a stiff neck before passing away.
Although initial screenings on the donor did not show rabies, further tests on kidney samples post-transplant revealed the presence of the virus. It was determined that the donor had died from rabies, which was transmitted through the transplanted kidney. The investigation pointed to a transmission chain involving a bat infecting a skunk, the skunk infecting the donor, and the donor transmitting the virus through the kidney transplant.
The incident, classified as exceptionally rare due to the low prevalence of rabies in the US and the complexity of its diagnosis, highlighted the minimal risk of transplant-transmitted infections. As a precautionary measure, cornea grafts from the donor were removed, and the recipients received appropriate medical treatment. Despite the ordeal, the three individuals who received the cornea grafts remained asymptomatic.
The CDC emphasized that donor risk assessments often rely on family reports of potential exposures to infected animals due to the infrequency of rabies screening in organ donors. Dr. Lara Danziger-Isakov from Cincinnati Children’s Hospital Medical Centre described the event as highly uncommon, reassuring the public about the overall minimal risk associated with such transmissions.