United States — A fatal case of rabies transmitted through an organ transplant has intensified global discussion on transplant safety and infectious disease surveillance. According to investigations by the US Centres for Disease Control and Prevention (CDC), a man died after developing rabies traced directly to a kidney he received from a donor unknowingly exposed to an infected animal.
Rabies is a viral infection with a near-inevitable mortality rate once clinical symptoms begin. Typically spread through the saliva of infected animals such as dogs, bats or raccoons, the disease rarely passes between humans. Nonetheless, scientific literature has documented instances where contaminated organs or tissues became the route of infection. A systematic review published in 2018 identified at least 13 confirmed cases of rabies transmission linked to organ or tissue transplantation between 1978 and 2017.
The most recent case in the United States involved a man who received a kidney from a donor whose infection risk had not been recognised during screening. The donor had died shortly before the transplant, and no rabies warning signs were identified at the time. Only later was it discovered that he had sustained a raccoon scratch — a detail that was overlooked as clinically insignificant.
Approximately 51 days after surgery, the recipient began to experience severe neurological symptoms and died soon after. Post-mortem testing revealed rabies viral RNA in the transplanted kidney, confirming the transmission route.
Three other individuals received corneal grafts from the same donor. As a precaution, medical teams removed these tissues and provided post-exposure prophylaxis — the recommended treatment when rabies exposure is suspected. None of these patients developed illness, according to the CDC. This marks the fourth documented rabies case linked to transplantation in the United States since 1978.
Health specialists emphasise that rabies is so uncommon in humans that it does not routinely feature among standard diagnostic tests for organ donors. Adding to the challenge, rabies incubation periods can range from days to over a year, complicating timely risk detection.
Experts now argue that donor screening must pay closer attention to seemingly minor events, including recent contact with wildlife, scratches, unexplained neurological symptoms and animal encounters. Such information could be crucial when determining organ safety.
Where rabies exposure is suspected, guidelines recommend immediate action: removal of transplanted tissue when feasible, prompt initiation of post-exposure treatment, and thorough epidemiological investigation. The same awareness should extend to healthcare services responsible for assessing donor suitability.
The episode underscores a critical message: while organ donation saves lives, success relies on stringent safety protocols. Although transmission of rabies via transplanted organs is exceedingly rare, the infection’s near-universal fatality once symptoms emerge means that even small lapses may have irreversible consequences.