Tragic Rabies Transmission: From Skunk Scratch to Organ Transplant Fatality
In an extraordinarily rare medical incident, a Michigan man died in January 2025 from rabies contracted through a kidney transplant from an Idaho donor who had unknowingly carried the virus. The donor, an unidentified man, had been scratched by a rabid skunk weeks earlier while heroically intervening to protect a kitten on his rural property. This marks the 10th documented case of rabies transmission via organ or tissue transplant in the U.S. since 1978, and only the fourth involving solid organs like a kidney.
Timeline of Events
The chain unfolded over several months, highlighting how rabies—nearly always fatal once symptoms appear—can lurk undetected in donors:
| Date | Event |
|---|---|
| Late October 2024 | Idaho donor, holding a kitten in an outbuilding on his property, is approached by a skunk displaying aggressive behavior. He fights off the animal, which scratches his shin (but does not bite him). The skunk is left unconscious; the donor sustains a bleeding wound but dismisses it as minor. |
| Early December 2024 | About five weeks later, the donor experiences subtle symptoms like hallucinations, difficulty swallowing, and mobility issues but is found unresponsive and presumed to have suffered a cardiac arrest. He dies shortly after; his organs (heart, lungs, left kidney, and corneas) are donated per his wishes. |
| Mid-December 2024 | The left kidney is transplanted into a Michigan man at an Ohio hospital. Initial donor screening (via the Donor Risk Assessment Interview) notes the skunk scratch but flags no rabies risk, as routine tests don’t screen for it. |
| Late January 2025 | Five weeks post-transplant, the recipient develops tremors, weakness, confusion, urinary incontinence, fever, hydrophobia (fear of water—a hallmark rabies symptom), and neurological issues. He is hospitalized and dies 51 days after the surgery (7 days after admission). |
| February 2025 | CDC postmortem tests confirm rabies virus RNA (silver-haired bat variant) in the recipient’s saliva, skin, and brain tissue. Retrospective analysis of donor samples shows negative serum antibodies but positive virus in archived kidney biopsies, verifying transmission. The skunk likely acquired rabies from a bat, creating a “three-step chain”: bat → skunk → donor → recipient. |
Investigation and Public Health Response
The CDC’s Morbidity and Mortality Weekly Report (MMWR), released in early December 2025, detailed the case after Ohio clinicians alerted authorities in January. Key findings:
- Virus Variant: Consistent with silver-haired bat rabies, common in Idaho but unusual in skunks (not a primary reservoir there).
- Other Donations: The donor’s heart and lungs were used for medical training (untestable); corneas went to two recipients, who received prompt post-exposure prophylaxis (PEP)—a vaccine and antibodies—and showed no symptoms. No broader public risk from these.
- Exposures Tracked: Officials assessed 370 contacts (349 healthcare workers, 18 community members, plus the cornea recipients). Of these, 46 (about 13%)—including 4 community contacts exposed to the skunk/donor and 33 healthcare workers—were recommended for PEP. All complied, and none developed symptoms.
This case underscores gaps in donor screening: While scratches from potential rabies carriers (bats, raccoons, skunks, foxes) are noted, rabies testing isn’t standard due to its rarity (1-3 U.S. human cases annually, mostly from bats). Officials emphasize that transplant risks remain “exceptionally low,” but it may prompt enhanced protocols for animal exposure histories.
Broader Implications
Rabies claims ~59,000 global lives yearly, but U.S. PEP prevents most exposures if given pre-symptoms. This incident, while heartbreaking, averted wider spread through swift tracing. It also spotlights the donor’s selfless act—saving a kitten—and his legacy in organ donation, albeit tragically flawed. For those in rabies-prone areas, prompt wound care and PEP consultation after animal encounters are crucial.