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A woman who died after undergoing a double lung transplant at the University of Michigan School of Medicine in Ann Arbor is the first person known to contract COVID-19 from lungs from donors, according to a new case report published in the American Journal of Transplantation.
“As far as I know, this is the first, and actually the only, documented transmission of COVID-19 to a recipient” of donated organs, said Bruce Nicely, clinical director of Gift of Life Michigan, a federally designated organ recovery agency and program state tissues.
The case is rare and represents “the worst case scenario” of a pandemic that killed half a million Americans, said Nicely, noting, however, that Gift of Life Michigan was not involved in this donation. The transplant took place in late October and the donor was from outside the state.
The woman who had the double lung transplant had chronic obstructive pulmonary disease and a negative test for coronavirus using a rapid polymerase chain reaction (PCR) test 12 hours before surgery, details the case report.
The organ donor, a woman from the Upper Midwest who suffered brain death after a car accident, also had a negative PCR test using a nasopharyngeal swab 48 hours after obtaining her organs.
The donor’s family reported that she had no known travel history and had no recent symptoms of COVID-19. It was not clear whether the organ donor had exposure to a person infected with the virus.
“By definition, this donor was asymptomatic,” said Dr. Daniel Kaul, who is the director of the University of Michigan’s Infectious Diseases Transplant Service and was among the study’s authors. “But it is important to recognize that the donor was tested with a standard PCR and was negative, and that the test was repeated on the same sample and was negative again.
“In most asymptomatic carriers, the vast majority – more than 90% – would have a positive test.”
One day after the transplant, the recipient’s heart was not pumping with the expected efficiency, and two days after the transplant, she developed fever, low blood pressure and difficulty breathing.
Doctors collected fluid samples from his lungs using what is known as bronchoalveolar lavage and tested this fluid for SARS-CoV-2. The results were positive.
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The same type of fluid from the organ donor was also tested for coronavirus and also showed a positive result.
Soon after, a thoracic surgeon who performed the transplant surgery also tested positive for the virus. Sequencing the complete genome of all three people showed that the disease probably originated in the organ donor and spread to the recipient and the surgeon during the transplant.
The woman who had the double lung transplant was treated for COVID-19 at the hospital and received the antiviral drug remdesivr and convalescent plasma, as well as steroids, but her condition worsened. She died about two months after the transplant surgery.
The case presents a dilemma for transplant doctors: people who need organ transplants are at high risk of dying without them, but there is no way to definitively prove that an organ donor may not have a disease like COVID-19.
“You can’t prove 100% that someone doesn’t have something because we don’t have perfect tests,” said Kaul. “So we tried to put together a combination of his exposures, his medical history, tests, radiology like a CT scan of the donor’s lung, which was done and showed nothing that looked like COVID.
“We do all these things and say, ‘Well, as best as we can determine, this donor is safe to use.’ But, unfortunately, in this case, there was asymptomatic COVID that was not detected by the standard test. “
Kaul suggested that organ procurement organizations should use lung fluid samples to test COVID-19 before transplantation. Nicely of Gift of Life Michigan said on Monday that the organization is in the process of doing this standard procedure for lung donations.
In this case, no other donor organs were used for transplantation.
The study authors cautioned that this case cannot be used to suggest that there is a risk of coronavirus infection when other organs, such as the kidneys, liver, heart or pancreas, may represent in the transplant.
“In the spring, the number of transplants in highly affected areas like southeastern Michigan actually dropped dramatically,” said Kaul.
There were concerns about whether transplants could be done safely when the virus was so widespread, he said, and whether hospitals had staff and resources to do transplants when they were flooded with seriously ill patients with COVID-19.
“Part of that was the concern about what would happen to someone immediately after the transplant who could receive COVID and the best way to track donors,” he said.
“I have no doubt that there were other donors with COVID whose organs were used, but the recipients did not become ill, and that may be because other organs besides the lungs were used. It is possible that there have been other cases where there has been transmission and results bad, but it wasn’t obvious and nobody tested it. “
This case, he said, is incredibly rare.
“I don’t think that people with organ failure who need organ transplants should be afraid to contract COVID with the organ transplant,” said Kaul. “This is the good news and if you have organ failure, a lot of bad things can happen to you … For the vast majority of people, the risk of declining an organ when it is offered is much greater than the risk of transmission of this donor virus or other infections that we try and find, but not always. “
Very well said, a death like that after the transplant is doubly devastating.
“Our hearts are with the recipient’s family as well as the donor’s family,” said Nicely. “If the recipient of Organs donated organs dies, it is sometimes a kind of double tragedy for the donor’s family as well.
“This case certainly represented one of the great challenges for donation and transplantation in the age of a pandemic. There are tests and there is the fact that about 110,000 people on the waiting list have no respite in their organ in the final stage of the disease. there is a pandemic. The disease continues to cause damage. They remain on the waiting list.
“The donation saves lives,” he said. “It really matters. So, despite a pandemic. The need and the possibility of doing good remain.”
Contact Kristen Shamus: [email protected]. Follow her on Twitter @kristenshamus.