A woman who died after undergoing a double lung transplant at the University of Michigan Medical School in Ann Arbor is the first known person to contract COVID-19 from donor lungs, according to a new case report published in the American Journal of Transplantation.
“To my knowledge, this is the first, and actually the only, documented transmission of COVID-19 to a recipient” from donated organs, said Bruce Nicely, chief clinical officer of Gift of Life Michigan, the state’s federally designated organ and tissue recovery program.
The case represents “the worst-possible scenario” to play out in the pandemic that has killed more than half a million Americans, Nicely said, noting, however, that Gift of Life Michigan was not involved in this donation. The transplant occurred in late October and the donor was from out of state.
The woman who underwent the double lung transplant had chronic obstructive pulmonary disease, and tested negative for coronavirus using a rapid polymerase chain reaction (PCR) test 12 hours prior to surgery, the case report details.
The organ donor, a woman from the Upper Midwest who suffered brain death following an auto accident, also had a negative PCR test using a nasopharyngeal swab within 48 hours of when her organs were procured.
The donor’s family reported that she had no known history of travel and didn’t have any recent COVID-19 symptoms. It was unclear whether the organ donor had exposure to a person infected with the virus.
A day after the transplant, the recipient’s heart wasn’t pumping as efficiently as expected, and two days after the transplant, she developed a fever, low blood pressure and respiratory distress.
Doctors collected samples of fluid from her lungs using what’s known as a bronchoalveolar lavage, and tested that fluid for SARS-CoV-2. The results were positive.
The same type of fluid from the organ donor was then also tested for coronavirus, and also yielded a positive result.
Soon after, a thoracic surgeon who performed the transplant surgery also tested positive for the virus. Whole genome sequencing of all three people showed that the disease likely originated in the organ donor, and spread to the recipient and the surgeon during transplantation.
The woman who had the double lung transplant was treated for COVID-19 in the hospital, and was given the anti-viral medicine remdesivir and convalescent plasma as well as steroids, but her condition worsened. She died about two months after her transplant surgery.
The research suggests transplant centers and organ procurement organizations should consider testing lower respiratory tract samples of potential lung donors to ensure the virus won’t be passed to transplant recipients. It also suggests that health care workers should don full personal protective equipment, including eyewear and N95 masks, when performing lung transplant surgeries and organ procurement.
“Our hearts go out to the recipient’s family as well as the donor’s family,” Nicely said. “If the recipient of donated organs dies, it’s sometimes kind of a double tragedy for the donor family, too.
“That case represented certainly one of the huge challenges for donation and transplantation in the age of a pandemic. There’s testing, and there’s the fact that those 110,000 or so people on the waiting list don’t get a respite to their end-stage organ disease. It does not take a pause just because there’s a pandemic. Their disease continues to take its toll. They remain on the waiting list.”
In this case, no other organs from the donor were used for transplant. The study’s authors cautioned that it can’t be used to suggest there is a risk of coronavirus infection when other organs, such as kidneys, liver, heart or pancreas, may pose in transplantation.
“I don’t think in our field there’s ever an absolute elimination of risk in transplantation,” Nicely said. “Everything is … relative because it is a matter of life and death, typically, for the recipient. And so the risk factors tend to be weighed against the state of the patient’s health, the progression of the disease that has landed him on the transplant waiting list, and all the factors that are known about the donor, along with consideration and acknowledgment that there are probably some unknowns because testing remains imperfect for everything.
“We have fantastic technology for testing for infectious disease, but no one could absolutely guarantee the absence of a pathogen so what we do is test every donor.
“Donation does save lives,” he said. “It really does matter. So, despite a pandemic. The need and the possibility to do good remain.”