A Michigan woman contracted COVID-19 and died last fall after receiving a double lung transplant, doctors said. The organs were infected with coronavirus, even though the donor initially gave negative results and showed no signs of disease.
It appears to be the first confirmed case in the US of transmitting from the donor to the recipient of SARS-CoV-2, the virus that causes COVID-19, according to a study published earlier this month in the American Journal of Transplantation.
“We would not have used our lungs at all if we had had a positive Covid test,” Dr. Daniel Kaul, director of the Michigan Medicine Infectious Diseases Transplant Service and co-author of the study, told Kaiser Health News. “All the screenings we do and we’re able to do, we’ve done.”
Neck and nose samples collected from the donor, a woman who died after suffering a severe brain injury in a car accident, gave negative results for the virus. Such samples are typically collected from both organ donors and recipients and tested for infection.
The donor did not travel recently and did not have a recent fever, cough, headache or diarrhea, said the family of the doctors’ donors. It is not known if the donor has had recent exposure to someone known or suspected of being infected.
The woman who received the transplant was a patient with chronic obstructive pulmonary disease at Ann Arbor University Hospital. She tested negative for COVID-19 a few hours before the transplant procedure.
Three days after the operation, the patient developed a worsening fever, low blood pressure and respiratory problems. Doctors decided to test samples taken from the patient’s nose and throat, as well as the lower respiratory system for COVID-19, after he developed septic shock and heart function problems. The nose and throat sample returned negative, but the lower respiratory sample was positive.
The doctors then tested a sample they had saved from the donor’s lower respiratory tract. It gave positive results for the virus.
The patient’s condition continued to worsen over the next few weeks. She experienced multisystem organ failure and developed worsening of respiratory respiration. She was treated with the antiviral drug remdesivir and received convalescence twice, but her condition continued to decline.
He died two months after receiving a double lung transplant.
The lung transplant surgeon tested positive for COVID-19 four days after the transplant procedure. He fell ill, but later recovered. Ten other members of the transplant team tested negative for the virus.
Genetic screening showed that the recipient of the transplant and the surgeon were extremely likely to have been infected by the donors’ lungs.
Nearly 40,000 transplants were performed in the US in 2020, suggesting that this type of COVID-19 transmission is extremely rare. Non-lung donors – those donors of organs such as the kidneys, hearts and liver – seem unlikely to transmit the virus even if they have it, Kaul said.
However, the case prompted doctors to request more detailed donor tests.
The organ procurement and transplant network, which oversees US transplants, does not require routine COVID-19 testing of donors. The results of the study suggest the need for more extensive pre-transplant testing, especially in areas with high infection rates, Kaul told Kaiser Health News.
Moreover, health workers present during the transplant procedure in this case were not required to wear N95 masks and eye protection, as both the donor and the recipient tested negative for COVID-19. The doctors who wrote this study said that such health care workers should consider wearing both N95 masks and eye protection, even if donors and recipients are negative.
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