Donor Screening: The Case of Rabies Transmission
Welcome back! Today we’re highlighting a case from the Centers for Disease Control Prevention (CDC) of rabies transmission via an organ transplantation. Reported in the Morbidity and Mortality Weekly Report of the CDC, rabies is a fatal (but preventable) viral infection most commonly transmitted to humans through the bite or scratch of an infected animal [1] . Rabies affects the central nervous system leading to severe brain disease and death if a person does not receive medical care (post-exposure prophylaxis, PEP) before symptoms start. Rabies transmission through organ or tissue transplantation is rare but poses significant risk due to the severity and fatality of the disease.
In January 2025, a kidney transplant recipient died from rabies fifty-one (51) days post-transplant. Prior to this, three (3) transplant-related cases between 1978 and 2013 involved nine (9) recipients in the United States. The kidney donor had been scratched by a skunk six (6) weeks prior to death which was not initially reported during donor screening. The rabies virus RNA (Ribonucleic Acid) was detected in the donor’s kidney which confirmed the organ-derived transmission [2]. Three (3) cornea recipients who received other tissue from the kidney donor underwent precautionary graft removal and received PEP and these patients remained asymptomatic.
During the investigation, the kidney recipient exhibited neurological symptoms such as tremors, confusion, and hydrophobia [3] (“fear of water”) which led to hospitalization prior to death and rabies confirmed postmortem. This instance was the fourth documented case of rabies transmission through organ transplant. Current practices do not routinely test for rabies in organ donors due to its rarity and diagnostic complexities. Public health officials conducted risk assessments for over three hundred (300) individuals who were potentially exposed to the donor or recipient, with 96% completed evaluations and 13% recommended for PEP.
This case underscores the importance of thorough donor evaluations and the need for public health collaboration in transplant scenarios. Enhanced awareness and protocols regarding rabies exposure can mitigate risks associated with transplantation. The CDC recommends thorough evaluation of donor medical history, especially for unexplained neurological symptoms, and possible exposures to animals that may carry rabies. Increased awareness and consideration in cases of unexplained central nervous system disease are vital to prevent transmission.
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References
[1] https://www.cdc.gov/rabies/about/index.html#:~:text=Rabies%20is%20a%20fatal%20but,not%20received%20before%20symptoms%20start
[2] https://www.cdc.gov/mmwr/volumes/74/wr/mm7439a1.htm
[3] https://my.clevelandclinic.org/health/diseases/22958-aquaphobia-fear-of-water