Rabies Contracted by Organ Transplant

The Centers for Disease Control and Prevention (CDC) and Maryland Department of Health and Mental Hygiene have confirmed that a patient who recently died of rabies in Maryland contracted the infection through organ transplantation done more than a year ago.  The patient was one of four people who had received an organ from the same donor.  This week, CDC laboratories tested tissue samples from the donor and from the recipient who died to confirm transmission of rabies through organ transplantation.

In early March, the Maryland Department of Health and Mental Hygiene initiated an investigation after the organ recipient died, which led to the rabies diagnosis. The investigation revealed that the organ recipient had no reported animal exposures, the usual source of rabies transmission to humans, and identified the possibility of transplant-related transmission of rabies, which is extremely rare.

The organ transplantation occurred more than a year before the recipient developed symptoms and died of rabies; this period is much longer than the typical rabies incubation period of 1 to 3 months, but is consistent with prior case reports of long incubation periods.  CDC’s preliminary laboratory analysis indicates that the recipient and the donor both had the same type of rabies virus—a raccoon type.  This type of rabies virus can infect not only raccoons, but also other wild and domestic animals. In the United States, only one other person is reported to have died from a raccoon-type rabies virus.

In 2011, the donor became ill and was admitted to a healthcare facility in Florida and then died.  At that time, the donor’s organs, including the kidneys, heart, and liver, were recovered and sent to recipients in Florida, Georgia, Illinois, and Maryland. At the time of the donor’s death, rabies was not suspected as the cause and testing for rabies was not performed.  Rabies was only recently confirmed as the cause of death after the current investigation began in Maryland.

Shortly before becoming ill, the donor had moved to Florida, but was a previous resident of North Carolina where it is believed the exposure may have occurred.  How the donor may have gotten rabies is currently under investigation.

The three other people who received organs from the donor have been identified and are currently being evaluated by their healthcare teams and receiving rabies anti-rabies shots (immune globulin and anti-rabies vaccination).  CDC is working with public health officials and healthcare facilities in five states (Fla., Ga., Ill., Md., and N.C.) to identify people who were in close contact with the initial donor or the four organ recipients and might need rabies post-exposure treatment.

All potential organ donors in the United States are screened and tested to identify if the donor might present an infectious risk. Organ procurement organizations are responsible for evaluating the suitability of each organ donor. Donor eligibility is determined through a series of questions posed to family and close contacts, a physical examination, and infectious disease testing, including HIV and hepatitis. There are typically one to three cases of human rabies diagnosed annually in the United States each year.  If rabies is not clinically suspected, laboratory testing for rabies is not routinely performed, as it is difficult for doctors to confirm results in the short window of time they have to keep the organs viable for the recipient.

Organ screening is designed to ensure safe and successful transplantations.  The benefits from transplanted organs generally outweigh the risk for transmission of infectious diseases from screened donors.

Rabies is a preventable viral disease of mammals most often transmitted through the bite of a rabid animal. The rabies virus infects the central nervous system, ultimately causing disease in the brain and death within days of the onset of illness. In the United States, bats, raccoons, skunks, and foxes are the most commonly reported rabid animals. However, bats remain the animal most frequently associated with transmitting rabies to humans.

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