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Extensive screening is routinely performed to prevent donor-associated infections in transplant recipients. When a kidney recipient died of rabies in February 2013 with no apparent exposure to a rabid animal, an investigation was initiated to determine whether he had acquired the virus through his transplant.
The kidney came from a previously healthy man who developed an unexplained neurologic illness in August 2011. He presented with nausea, vomiting, and paresthesias, which progressed to dysphagia, seizures, obtundation, hypothermia, and hemodynamic instability. Premortem and postmortem studies were nondiagnostic, and four organs (2 kidneys, heart, and liver) were donated. Although at the time of donation, the donor's family members indica…