FTA: “only four donors have transmitted rabies to recipients since 1979”
ONLY?! Rabies cases are really uncommon! I’m seeing 17 in the us from 2015-2024. Even assume double or triple the rates in earlier decades and, what, maybe 200 since 1978? 2-4% chance a given person who dies of rabies has their organs given to someone else? That’s an order of magnitude higher than I’d have guessed. WTF.
From the CDC report [1], it's pretty clear that rabies was not considered for the donor until after the donee died and rabies was confirmed. Possibly because the donor had been scratched by a skunk and not biten. The report says the scratch had been noted on the donor risk assessment interview (DRAI), but that skunks are not considered a reservoir for rabies in his area.
Theoretically, the donor could die before the rabies infection developed into a disease. For example, in a car crash. IDK if this was ever the case. The incubation period is definitely long enough for this to be a plausible scenario.
Going by wikipedia, the incubation period can be up to three months. That isn't a particularly significant span of time if we're measuring how likely someone is to suffer an unexpected death. It's long enough that the possibility exists, but that's about all you can say.
But the question isn't "what are the odds someone who dies in this period has rabies" it's "what are the odds someone who died after being infected with rabies died before they started showing symptoms" so the rarity of people incubating rabies is irrelevant.
Further, rabies incubation is highly variable - symptoms may not appear for years.
ONLY?! Rabies cases are really uncommon! I’m seeing 17 in the us from 2015-2024. Even assume double or triple the rates in earlier decades and, what, maybe 200 since 1978? 2-4% chance a given person who dies of rabies has their organs given to someone else? That’s an order of magnitude higher than I’d have guessed. WTF.