On the day he lost consciousness and fell into a coma in December 2024, James Martin seemed to be talking to someone in his bedroom who didnt exist.

I had to go wake him up and go, Honey, who are you talking to? Kim Martin, his widow, recalled.

No one knew it at the time, but medical professionals believe James, 59, had been infected with rabies about five weeks earlier, during an encounter with a skunk in the front yard of his Idaho home.

The delirium may have been a symptom of the fatal disease that had been quietly working its way through his system.

We had no idea, Kim said.

Her husband and the father of their three kids had ongoing health problems in the preceding months that may have made it difficult to see what was really happening to his body.

Due to nerve issues with his legs, it was challenging for him to walk or get out of bed. In the morning, she found him talking to himself. She said he told her he needed to go to the restroom, but she was not strong enough to support his weight to help him get there. So, she brought him a jar and gave him some privacy.

She told her husband to call for her when he needed her help back in the room.

But he never called for her.

It was like, Why isnt he calling me? Kim said. I came back in, and...he was collapsed on the floor. His face was blue.

She tried CPR to bring her husband back to life, but he would remain in a coma until he passed away a few days later.

At the time, his death seemed like a heart-related issue, so his organs untested for rabies - were donated to recipients and researchers in six states.

How investigators believe James contracted rabies

James Martin loved puns and poetry and cuddling with his three kids as they grew up.

He had a soft spot for cuddly animals, too especially the feral cats he and his wife would rescue near their rural home in the Idaho panhandle.

He was particularly fond of one tiny white kitten they rescued in the fall of 2024.

He just picks her up ... and just cuddles her like a little baby, said Kim. To him, it was his grandchild.

In October that year, the kitten was perched on James arm as he sat in his wheelchair inside a small shed at the front of his house when an aggressive skunk approached James on the property.

His protective instinct took over, and James stunned the skunk before it could attack the kitten.

He said he grabbed it by the neck, and he literally, you know, pushed it up against the house, Kim said. He said he just gave it a few punches and everything, but in grabbing it, he said he got scratched.

James downplayed the wound on his left shin.

Hes like, Im - Ill be fine. Its just a scratch. Ill just put, you know, Neosporin on it, and Ill be fine after I get it cleaned, Kim remembered.

But he wasnt fine.

Over the next few months, that scratch would lead to a series of medical catastrophes.

James was an organ donor

The first day James was in the hospital, Kim said she learned her husband had signed up to be an organ donor.

"It just made me smile and go, 'Thats him. Thats just him. Like, thats the big, tender panda bear of him, to help someone else, she said.

She said she answered multiple questions from medical professionals about her husbands health history and disclosed that he had been scratched by a skunk.

According to the CDC, the information about the skunk scratch was documented among many other details on a Donor Risk Assessment Interview (DRAI) questionnaire, a standard set of questions to help evaluate the safety of a transplant.

The transplant process proceeded.

Within a few days, doctors had prepared James heart and lungs to be shipped to Maryland for research, while his kidney went to Ohio. Tissue from his corneas was designated for recipients in Idaho, Missouri, California, and New Mexico.

Why didnt anyone test for rabies?

While federal guidelines required James organs to be tested for more common diseases like HIV and hepatitis before being shipped to transplant recipients around the country, a laboratory screening for rabies is not a standard procedure because the test is complicated and the disease is incredibly rare.

Fewer than 10 people die each year from rabies, according to the CDC, and in December 2024, there had only been three documented incidents of rabies transmission through organ donation since 1978.

The testing is very complex and can only be done at certain centers, said David McCormick, a medical officer in the CDCs Office of Blood, Organ, and Other Tissue Safety who helped investigate this case but was not involved in the transplant.

Given that there is such a need for organs and that timing in organ donation can be very critical, if we had to wait two or three days to test every organ donor for rabies...that could delay care, could delay people receiving organs that they need, and just with how rare rabies is, it wouldnt be cost effective and would likely result in organs not being used when they couldve been used and couldve saved people, he said.

Who received the infected organs and tissues?

In December 2024, Barney Kurowicki, a father of four grown children and the grandfather to 11, was hoping for a life-prolonging kidney transplant after enduring dialysis for more than two years.

The retired postal worker and farmer was living in Tecumseh, Michigan, when he was added to a national list of hopeful transplant recipients.

According to legal filings, within four days of being placed on the donor registry, Kurowicki was offered a kidney by an organ procurement organization, and the surgery was scheduled for the next day at the University of Toledo Medical Center in Ohio.

Though the donors name was kept confidential because the process is anonymous, Scripps News has learned the organ was coming from James Martin.

At the time, his death was still believed to have been heart-related.

Symptoms of rabies start to manifest

By January 2025, things were not going well with Barney Kurowickis transplant.

He started experiencing tremors, lower extremity weakness, confusion, and urinary incontinence, according to a CDC report, which did not disclose Kurowickis name publicly.

Kurowicki, who was rapidly deteriorating, also suffered from hydrophobia, a symptom that is associated with rabies.

Your throat swells up a little bit, so its actually painful to drink and swallow, said Ryan Wallace, a veterinary epidemiologist who leads the CDCs rabies team in Atlanta. But its more of a neurologic effect, and so people are truly afraid of water.

By the time the symptoms manifested themselves in Kurowickis body and healthcare workers called the CDC for a consultation, it was too late to save his life.

Meanwhile, a group of patients in Idaho, New Mexico, California, and Missouri had either already undergone cornea graft procedures or were preparing for surgery using the same donor's cornea tissue.

The rabies hotline call that kicked off a CDC investigation

When Kurowickis medical team alerted the CDC about his symptoms, they did so via a special rabies hotline.

It gets about 2,000 inquiries a year, said Wallace. This one came in through a healthcare provider who called that hotline and was directed to one of our epidemiologists who took the initial consultation.

Each year, the CDC handles about 150 consultations based on those calls, but only approximately 50 cases meet the criteria that lead to testing at the CDC, according to Wallace.

Of those, fewer than five test positive annually.

Its still a relatively rare outcome that these people have rabies, said Wallace. A lot of things look like rabies.

The Kurowicki case, however, had enough red flags that it triggered immediate testing at the CDC.

The fact that he was an organ recipient, you know, certainly makes you a little concerned that there is a potential that this was donor derived. But theyre so rare, its not the first thing wed expect to have happen, said Wallace.

Since the CDC team did not initially have a complete picture of the donors contact with a skunk, health workers first investigated whether Kurowicki, the recipient, had any exposure to wild animals in recent weeks.

He had not.

This patient had two clinical signs that I was really concerned about, but the lack of an exposure history, I wasnt jumping up and down going, This is rabies, we need to act.

A few days later, test results would confirm that rabies had killed Kurowicki.

Determining where the virus originated was another challenge.

The rabies testing process

The testing process for rabies is complex, according to the CDC, and the samples can take several days to process.

If the patient is still alive, we need four different types of samples, said Rebecca Earnest, an epidemic intelligence service officer for the CDC. We need saliva. We need a biopsy from the skin from the back of a persons neck. Were trying to get at these little nerves at the base of the hair follicle. We need serum, and we need cerebrospinal fluid.

Earnest said the sample collection method is very specific and can be invasive.

Our laboratory at CDC is the only one in the country that tests for human rabies for all residents, she said.

Waiting for the rabies test results

Those first five to seven days were pretty stressful with a lot of phone calls largely around the idea of: do we start vaccinating people before we even know this is a rabies case? said Wallace.

Post-exposure prophylaxis, or PEP, is a series of vaccine shots administered to someone after they have been exposed to rabies. The treatment may cost thousands of dollars and is only effective before rabies symptoms develop.

We usually do not advise that until a confirmed diagnosis of rabies is made, said Wallace, citing the rarity of the disease, the expense of the vaccine, and supply limitations.

However, this case was unique, with multiple transplant recipients potentially at risk.

Because (rabies)... is effectively 100% fatal after symptoms begin, if you havent received rabies PEP, we always recommend that people really reach out to their doctor if they think they may have been exposed, said Earnest.

Rabies is considered to be a medical urgency rather than an emergency, according to Earnest, due to the incubation period of the disease. The time from the infection to when the symptoms actually start may take weeks to months, she said.

Its not something that you get infected and...two days later, youre going to develop symptoms. There is a window there. However...because it is so fatal, we want people to get rabies PEP as soon as they find out they might have been exposed.

Although the origin of the rabies virus was still unconfirmed, health workers in multiple states worked together with the CDC to immediately alert anyone who had come in contact with the donors tissue or organs.

Dr. Christine Hahn, Idaho's state epidemiologist and the medical director for the states department of public health, helped with the process.

We mobilized very quickly and got on a call with CDC and other states that were impacted to talk about who all got these tissues, and working with the transplant organization, we were able to determine that really only corneas were the only other tissues that were donated, fortunately, she said.

Ultimately, hundreds of people were screened, and close to four dozen individuals - including some first responders, medical workers, and family members -received recommendations to get the rabies vaccine.

We really dont take any chances, and so, if we think you came in contact with possibly infectious tears, saliva, or innervated tissues like organs or corneas with broken skin or your ears, nose or mouth, we want you to get rabies PEP, said Earnest.

As part of the process, health officials advised the three people who had undergone cornea grafts with tissue from the infected donor to have their grafts removed and to receive vaccines.

Hahn said she spoke to the doctor of the Idaho patient who received a potentially infected cornea graft.

It was a pretty tense conversation. The doctor was very grateful for the information, absolutely agreed that the best thing to do was to remove the corneal tissue and also give the shots, the PEP, to prevent any possible rabies, she said. I can imagine the conversation he must have had with the ... patient and the family, how stressful that mustve been.

Health officials were able to prevent a fourth graft procedure from taking place.

None of the graft recipients experienced any rabies symptoms before receiving the vaccine, even though at least two people had received grafts more than six weeks earlier.

They were monitored for their immune response to make sure that they were mounting a strong immune response after receiving that vaccination, and they all remained asymptomatic, said Earnest.

The tissue from each graft procedure was also tested for rabies.