At a glance
Current policy
Rabies is a rare but very serious disease that affects the brain and nerves. People usually get rabies from the bite or scratch of an infected mammal. There is no test to diagnose rabies before symptoms start, and once symptoms begin, it is almost always fatal. Rabies can also spread through blood transfusions or organ transplants. This happened most recently in 2024. In April 2025, the Health Resources and Services Administration (HRSA) directed the Organ Procurement and Transplantation Network (OPTN) to find ways to lower the chance that a person will get a donated organ that has rabies. The OPTN is updating policies and collecting more information to better identify when an organ donor may have rabies.
Supporting media
Presentation
View presentation (PDF - 156 KB)
Proposed changes
- Create screening criteria (questions) to help identify if a living or deceased organ donor may have come in contact with and could have rabies
- If any risk of rabies is found from screening the donor, then organ procurement organizations (OPOs) and living donor transplant programs must contact the Centers for Disease Control (CDC) for additional help in reviewing the risk
- Require transplant programs to inform transplant candidates when an organ being offered has any known risk of having rabies
- Require recipients of organs at risk for rabies to be monitored after transplant and given post-exposure prophylaxis (PEP) when needed
Anticipated impact
- What it's expected to do
- Help keep patients safe by lowering the risk of getting rabies from an organ transplant
- Provide standard criteria (questions) to use to review an organ donor’s risk of exposure to rabies
- Require transplant programs to tell transplant candidates of possible rabies exposure risk when offered potentially affected organs
- What it won't do
- It will not automatically prevent someone from being an organ donor just because there is the possibility that they may have been exposed to rabies
Terms to know
- Post-Exposure Prophylaxis (PEP): Any preventative medical treatment started after exposure to a pathogen, like rabies, to prevent the infection from occurring.
- Rabies: A deadly viral disease affecting the brain and nervous system.
Read the full proposal (PDF - 557 KB)
Submit a comment
Please submit all comments via email to OPTNWeb@hrsa.gov. Comments will be posted on this page. Please share in your email if you would like your comment published anonymously.
Comments
Glenna Frey | 12/19/2025
I am a nephrology nurse, my family has kidney disease, and I am a living kidney donor.
- I support: Reduce the Risk of Donor Derived Rabies Transmission.
George Bayliss | 12/19/2025
This seems a very rare but devastating transmitted infection. My experience in asking patients if they’ve been exposed to skunks, raccoons is limited, but no one has acknowledged worrisome exposure. There is another rare, devastating infection in transplant patients – LCMV, from infected hamsters. There have been three cases of transplant infection from an infected donor – Wisconsin in 2003, Rhode Island in 2005 and Massachusetts in 2008. There hasn’t been a move to screen donors for this infection, which is as deadly as rabies in transplant patients. I would consider broadening this warning to cover limited but deadly infections and not limit it to rabies. That would allow it to be updated as new infections are discovered.
Jennifer A. Cowger | 12/19/2025
Thank you for the opportunity to submit a public comment on the HRSA Directive to Reduce the Risk of Donor Derived Rabies Transmission. For context, I am a heart transplant physician. I have also seen a rabies death once in my career (as a medical student). I am no rabies expert but I appreciate that death from rabies in the US is RARE. Less than TEN PEOPLE die of rabies every year in the US. The occurrence of death after an organ transplant was what a nonmedical person would call a clear fluke. I think it is reasonable to proactively ask about exposure to any animal known to be infected by rabies, or any known exposure to a bat, racoon, mongoose, fox, or skunk bite/scratch but table 1 data in the redacted proposal suggests that family are often not aware of contact with a rabid animal. Thus true benefit is of question (ie- what is the true positive predictive value of the question and what is true negative predictive value of the rabies question- both likely low).
The inclusion of feral or stray cats may create unnecessary anxiety and expose people to unnecessary PEP. People often have no clue if a cat is or is not stray/feral. Is it a distant neighbor’s cat that one does not know or truly a cat that lives outside and has not had rabies vaccination? I would suspect it is more likely that a person will get scratched or bit by an indoor cat that ran out of their house, got terrified, and scratched or bit a person agitating the scared feline. Is a cat that lives outside 24/7 on a farm- yet is fed and watered and lives in a barn- feral? Maybe that cat has or has not had a rabies vaccination? Much of America is still rural and keeps cats outside and may or may not vaccinate their cat, even as a pet. When we call the CDC, we are not going have clear answers to the question of feral vs domestic cat and vaccinated vs nonvaccinated cat. Given the rarity of rabies and frequency of cats and cat bites/scratches in the US, I feel this will potentially trigger a lot of angst, expensive testing and PEP that is unnecessary at this time for rare condition. If the frequency of rabies rises in the US beyond a given threshold of risk, then perhaps this is reasonable.
Mythreyi Govindarajan | 12/19/2025
Thank you for the opportunity to comment on the proposed changes related to rabies screening and risk mitigation in organ donation and transplantation.
I support this proposal and believe it represents a thoughtful and balanced approach to improving patient safety while preserving access to life-saving organ transplants. Rabies is a rare but fatal disease once symptoms develop, and the added safeguards outlined in this proposal are appropriate given the severity of the risk.
The creation of standardized screening questions will help ensure consistent evaluation of donor rabies exposure risk across organ procurement organizations and transplant programs. Requiring consultation with the Centers for Disease Control and Prevention when potential risk is identified is a practical and crucial step that adds expert guidance without automatically excluding donors.
I also strongly support the requirement to inform transplant candidates when an organ that is offered has a known potential risk of rabies exposure. Transparency is essential for informed consent and ethical decision-making. Additionally, post-transplant monitoring and the use of post-exposure prophylaxis when indicated provide more protection of recipients.
I strongly feel that the questions provided to the donor should avoid false positives, at the same time, not miss out any critical points.
Finally, this proposal does not unnecessarily restrict organ donation based solely on possible exposure, and this helps balance safety concerns with the ongoing need to maintain the organ supply.
Overall, I believe these changes will enhance patient safety, promote consistency, and strengthen trust in the transplant system.
Thank you for considering my comments.
University of Arkansas for Medical Sciences Solid Organ Transplant Department | 1/2/2026
We appreciate the opportunity to comment on the OPTN proposal to implement measures to reduce the risk of donor derived rabies transmission. We agree that implementing donor screening criteria to identify potential rabies exposure or infection could be beneficial and may provide valuable information to transplant centers when evaluating organ offers. Targeted screening questions have the potential to uncover rare but serious risks and support informed clinical decision making. While we acknowledge that consultation with the Centers for Disease Control and Prevention (CDC) can be helpful in assessing rabies risk, we caution against policies that would mandate CDC notification in a manner that could delay organ recovery and transplantation. Screening criteria that are overly sensitive or prone to false-positive risk flags may result in required CDC consultation that increases cold time, delays allocation decisions, and ultimately contributes to organ non-utilization or waste. We encourage OPTN to carefully balance risk mitigation with operational feasibility and organ preservation.
We agree that transparency with transplant candidates is critical and support timely notification to transplant centers when a donor is identified as potentially at risk for rabies. We recognize that discussing this information with candidates at the time of organ offer may be appropriate in certain circumstances. However, we note that transplant centers already counsel candidates regarding the possibility of unknown or undetected donor-derived infections. Requiring a specific discussion of rabies risk in all cases where screening criteria are met, particularly when the actual risk is low, may cause unnecessary anxiety and could lead to candidates declining otherwise suitable organs.
We support monitoring transplant recipients for rabies following transplantation when donor risk is identified and agree that post-exposure prophylaxis should be recommended as part of clinical guidance. However, we strongly believe that decisions regarding prophylactic treatment should remain under the clinical discretion of the transplant center, allowing care teams to individualize management based on recipient factors, donor risk assessment, and evolving clinical guidance.
In summary, we support efforts to enhance donor screening and reduce the risk of donor-derived rabies transmission. We encourage OPTN to ensure that screening requirements, CDC notification processes, and communication expectations do not inadvertently delay transplantation, increase organ discard, or limit transplant center autonomy in post-transplant management. Thoughtful implementation of this policy will be essential to protecting recipients while preserving timely access to organs.