A Michigan woman contracted COVID-19 and died last fall after receiving a double-lung transplant, doctors said. The organs were infected with the coronavirus, even though the donor initially tested negative and showed no signs of illness.
It appears to be the first confirmed U.S. case of donor-to-recipient transmission 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 absolutely not have used the lungs if we’d had a positive Covid test,” Dr. Daniel Kaul, director of Michigan Medicine’s transplant infectious disease service and a co-author of the study, told Kaiser Health News. “All the screening that we normally do and are able to do, we did.”
Throat and nose samples collected from the donor, a woman who died after suffering a severe brain injury in a car accident, had tested negative for the virus. Such samples are routinely collected from both organ donors and recipients and tested for infection.
The donor had not traveled recently and did not have any recent fever, cough, headache or diarrhea, the donor’s family told doctors. It’s unknown whether the donor had any recent exposure to someone known or suspected to be infected.
The woman who received the transplant was a chronic obstructive lung disease patient at University Hospital in Ann Arbor. She tested negative for COVID-19 several hours before the transplant procedure.
Three days after the surgery, the patient developed worsening fever, low blood pressure and respiratory problems. Doctors decided to test samples collected from the patient’s nose and throat as well as her lower respiratory system for COVID-19 after she developed septic shock and heart function problems. The nose and throat sample came back negative but the lower respiratory sample tested positive.
Doctors then tested a sample they had saved from the donor’s lower respiratory tract. It tested positive for the virus.
The patient’s condition continued to worsen for the next several weeks. She experienced multisystem organ failure and developed worsening respiratory distress. She was treated with the antiviral drug remdesivir and received convalescent plasma on two occasions, but her condition continued to decline.
She died two months after receiving the double-lung transplant.
The surgeon who performed the lung transplant 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 the transplant recipient and surgeon were extremely likely to have been infected by the donor lungs.
Nearly 40,000 transplants were performed in the U.S. in 2020, suggesting this type of COVID-19 transmission is exceedingly rare. It seems unlikely for non-lung donors ― those donating organs such as kidneys, hearts and livers ― to transmit the virus even if they have it, Kaul said.
Still, the case has prompted doctors to call for more thorough testing of donors.
The Organ Procurement and Transplantation Network, which oversees transplants in the U.S., doesn’t require routine COVID-19 testing of donors. The study’s findings suggest the need for more extensive testing before transplants, especially in areas with high infection rates, Kaul told Kaiser Health News.
What’s more, health care workers present during the transplant procedure in this case were not required to wear N95 masks and eye protection because both the donor and recipient had tested negative for COVID-19. The doctors who authored this study said such health care workers should consider wearing both N95 masks and eye protection moving forward even if donors and recipients test negative.