Kidney recipient dies in US after transplant from organ donor who had rabies

Summary

• A man in Idaho died from presumed heart attack but had rabies from a skunk scratch, leading to organ donation.
• A Michigan man received the donated kidney and died from rabies, highlighting the organ donation risk.
• Three cornea recipients were treated preventatively after one tested positive; since 1978, 7 of 13 died.

WASHINGTON - A man died of rabies after getting a kidney transplant from another man who died of the virus, only the fourth instance in nearly 50 years in which an organ donor passed the virus to a recipient, federal officials said.

The Centres for Disease Control and Prevention reported on Dec 4 that an Idaho man was on his rural property in October 2024 when a skunk approached him and scratched him on the shin.

About five weeks later, the man started to hallucinate, have trouble walking and swallowing, and had a stiff neck, according to the CDC report. Two days after his symptoms started, he collapsed of what was presumed to be a heart attack, the report said.

The man was unresponsive and taken to a hospital, where he died. Several of his organs were donated, including his left kidney.

A Michigan man received the donated kidney.

Five weeks after the transplant, he started to experience tremors, weakness, confusion and urinary incontinence, the report said. He was hospitalised a week later with symptoms including a fever, difficulty swallowing and fear of water, which is a telltale sign of rabies, the report said.

After a week in the hospital, he died.

Doctors treating the kidney recipient noted that the man’s symptoms were consistent with rabies.

The report said that organ donations are not routinely tested for rabies “because of its rarity in humans in the United States and the complexity of diagnostic testing”.

Donors are tested for HIV and several forms of hepatitis, Dr Lara Danziger-Isakov, the director of immunocompromised host infectious diseases at Cincinnati Children’s Hospital Medical Centre, said on Dec 5.

“This is an exceptionally rare event,” said Dr Danziger-Isakov, who is also a board member for the American Society of Transplantation, a professional association for those working in organ transplants. “Overall, the risk is exceptionally small.”

The hospital Dr Danziger-Isakov works for was not involved in the rabies-infected transplant, according to a hospital representative. The CDC report said the transplant operation had taken place at an unidentified Ohio hospital.

Doctors reviewed records about the kidney donor and learned that the Idaho man’s family had disclosed the skunk scratch to doctors when his organs were being donated, the report said.

It is believed that the skunk that scratched the donor contracted rabies from a bat, the report said. Testing revealed that the organ recipient and the donor had rabies consistent with the type found in bats.

Before the transplant, biopsies were done on both of the donor’s kidneys.

After the recipient tested positive for rabies, those biopsies were revisited. The biopsied tissue from the kidney that had not been transplanted tested positive for rabies.

The doctors were unable to test the tissue of the kidney that had been transplanted.

The Idaho man’s corneas were also donated, and ocular grafts were transplanted in three people, the report said.

The three patients’ grafts were removed, and one tested positive for rabies, the doctors said.

None of the three patients had symptoms of rabies, but they were being treated with preventive drugs, the report said.

Since 1978, four organ donors have passed rabies to 13 organ recipients, the report said. Of the 13 recipients, six who received treatment for rabies survived. The seven others, who did not receive treatment, died.

Fewer than 10 human deaths are attributed to rabies each year in the US, according to the CDC. More than 3,500 animals test positive for the virus annually.

In 2024, a record 48,149 organ transplants were performed, according to the Organ Procurement and Transplantation Network, the United Network for Organ Sharing reported. The organs came from a total of 24,018 deceased and living donors. NYTIMES