The CDC report said that the unnamed recipient, an adult man from Michigan, underwent kidney transplant surgery in December 2024 at an Ohio hospital, receiving the organ from an Idaho donor. About five weeks after the procedure, the man began experiencing tremors, weakness in his lower extremities, confusion, and urinary incontinence.
His condition deteriorated quickly. Seven days after symptoms appeared, he was hospitalized with fever, difficulty swallowing, and extreme sensitivity to water—a classic sign of advanced rabies. By the fourth day in the hospital, he required a breathing machine to survive. On the seventh day, he died.
The turning point in diagnosis came when hospital staff consulted with the Ohio Department of Health and the CDC after recognizing that the patient's symptoms matched those of rabies infection. Medical records revealed that the organ donor had sustained a skunk scratch.
Testing confirmed the diagnosis, as the rabies virus was detected in samples of the patient's saliva, skin tissue from his neck, and brain tissue. The virus matched a silver-haired bat rabies variant.
Investigators traced the infection back to the donor, an Idaho man who had encountered a skunk on his rural property in late October 2024. According to the CDC, the donor was holding a kitten in an outbuilding when a skunk approached. The skunk was left unconscious during the encounter, and the donor suffered a bleeding shin scratch, though he didn't believe he had been bitten.
About five weeks after the skunk encounter, the donor developed confusion, difficulty swallowing and walking, hallucinations, and a stiff neck. Two days after symptom onset, he was found unresponsive at home and was hospitalized, but never regained consciousness. He was declared brain dead five days later.
Laboratory analysis of archived kidney samples confirmed the rabies virus in the donor's organ, establishing that the infection had spread directly through the transplanted kidney.
The situation grew more complicated because the donor's organs were distributed to multiple recipients. While the kidney went to the Michigan man, three people from California, Idaho, and New Mexico received cornea tissue grafts from the same donor. A fourth planned cornea transplant to a Missouri patient was canceled.
Once rabies was suspected, those three cornea recipients underwent emergency graft removal and received postexposure prophylaxis—the rabies vaccine and immunoglobulin treatment that prevents the disease when given before symptoms appear. None of them developed rabies symptoms. The donor's heart and lungs were used for training purposes at a Maryland medical facility and were unavailable for testing.
Health officials identified 370 people with possible exposure to the skunk, the donor, or the kidney recipient; of those, 357 completed risk assessments. Among those assessed, 46 were recommended for treatment.
Among the four community members exposed to the donor and skunk, all received the treatment. Of 80 health care workers who had contact with the donor, 17 were recommended for treatment. For people who had contact with the kidney recipient, six of 14 community members and 16 of 256 health care workers were recommended to receive the same treatment.
There have been four documented transplant-transmitted rabies events since 1978, which involved 13 recipients, among whom seven who did not receive postexposure prophylaxis died, while all six who received it survived.