Three weeks ago, the US Centres for Disease Control (CDC) reported a rare case where a kidney transplant recipient died of rabies 51 days after the surgery. The infection was traced back to the organ donor. Since 1978, only four donors had passed rabies to 13 recipients. In Kerala, this news has raised worries because the state's organ donation program is still new, and rabies is a growing health problem. Over three lakh animal bites are reported yearly in Kerala. The Transplantation of Human Organs and Tissues Act, 1994, requires every organ donor to undergo medical evaluation, including checking for animal exposure and symptoms like unexplained encephalitis. Noble Gracious, executive director of K-SOTTO, said, "No nation specifically mandates rabies testing for all donors because human-to-human transmission of rabies is rare." India has not reported rabies cases from organ transplants but has seen two after corneal grafts. Donors already undergo tests for infections like HIV, hepatitis, syphilis, and Cytomegalovirus. They also get scans such as ultrasound and CT. Risks like animal exposure and fevers are checked. Dr. Gracious added, "Donor risk mapping and traceability are keys to safe, ethical, and effective organ transplantation and linked to patient safety and public trust." Kerala plans to expand its organ transplant program. Experts say stronger donor screening is needed for safety. However, this brings high costs for donor evaluation and maintenance. The law says donors' families should not pay these costs; instead, recipients, hospitals, or government must bear them. A critical care expert asked, "Who will bear huge expenses if donation does not proceed after donor screening and brain death certification?" K-SOTTO suggests creating a corpus fund to cover donor screening costs upfront. The fund would be reimbursed by recipients or hospitals after a successful donation. This approach will help hospitals certify brain death without hesitations due to costs. As Kerala's organ transplant program grows, addressing these challenges is vital to ensure safe and trustworthy transplants.