Rare Rabies Transmission Through Kidney Transplant in Michigan

A man in Michigan has died from rabies after receiving a kidney transplant from a donor who also succumbed to the disease. This unusual case involved the donor being scratched by a skunk while protecting a kitten, which public health officials are labeling as an “exceptionally rare event.”

According to a report from the Centers for Disease Control and Prevention (CDC), the Michigan patient underwent a kidney transplant at a hospital in Ohio back in December 2024.

About five weeks post-surgery, he started showing symptoms like tremors, weakness in his legs, confusion, and urinary incontinence. He was quickly hospitalized, put on a ventilator, and later passed away. After his death, tests confirmed he had rabies, which puzzled authorities as his family mentioned he hadn’t been around any animals.

When doctors checked the records of the kidney donor, who lived in Idaho, they found that he had reported being scratched by a skunk in a Donor Risk Assessment Interview (DRAI) questionnaire.

The donor’s family recounted that a couple of months earlier, in October, while he was holding a kitten in a shed on his property, a skunk approached with aggressive behavior towards the kitten. The man tried to fend off the skunk, which became unconscious during the struggle, but he got a bleeding scratch on his shin, although he believed he hadn’t been bitten.

A family member noted that shortly after the incident, he became disoriented, struggled with swallowing and walking, experienced hallucinations, and had a stiff neck. Two days later, he was found unresponsive at home, likely due to cardiac arrest. Although he was resuscitated and hospitalized, he never regained consciousness and was eventually declared brain dead after several days on life support.

The report indicated that multiple organs, including his left kidney, were donated.

When rabies was suspected in the transplant recipient, officials reviewed samples from the donor, which tested negative for rabies. However, kidney biopsies revealed a strain consistent with silver-haired bat rabies, indicating the donor had, indeed, died from rabies and transmitted it through the kidney.

The investigation proposed a “likely three-step transmission chain,” where a bat infected a skunk, which then infected the donor, leading to the infection of the transplant recipient.

The CDC classified this as only the fourth documented case of rabies transmission through transplant since 1978, emphasizing that the risk of such infections is very low.

Furthermore, after discovering that three additional recipients had received cornea grafts from the same donor, authorities swiftly removed the grafts and provided Post-Exposure Prophylaxis (PEP) to prevent potential rabies infections. All three individuals remained symptom-free, according to the report.

The CDC highlighted that family members usually provide critical information about a donor’s infectious disease risks, including any animal encounters. Because rabies is infrequent in humans in the U.S. and challenging to diagnose, it is generally “excluded from routine donor pathogen testing.”

The report noted that hospital staff treating the donor were initially unaware of the skunk scratch and attributed his early signs and symptoms to existing health issues.

Dr. Lara Danziger-Isakov, who oversees immunocompromised host infectious diseases at Cincinnati Children’s Hospital Medical Center, commented in a New York Times interview that this occurrence is “an exceptionally rare event” and reassured that the overall risk is very small.