The patient with organ transplant dies after receiving COVID-infected lungs

A Michigan woman contracted COVID-19 and died last fall after receiving a double lung transplant, doctors said. The organs became infected with the coronavirus, although the donor initially tested negative and showed no signs of disease.

It appears to be the first confirmed case in the United States of donor transmission to a 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 wouldn’t have used our lungs at all if we had had a positive Covid test,” Dr. Daniel Kaul, director of Michigan Medicine’s infectious disease transplant service and co-author of the study, told Kaiser Health News. “We’ve done all the projection we normally do and we’re able to do that.”

The throat and nose samples collected from the donor, a woman who died after suffering a serious brain injury in a car accident, had tested negative for the virus. These samples are routinely collected from both organ donors and recipients and tested for infection.

The donor had not traveled recently and had no recent fever, cough, headache or diarrhea, the donor’s family told doctors. It is unknown whether the donor 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. He tested negative for COVID-19 several hours before the transplant procedure.

Three days after surgery, the patient presented with 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 to detect COVID-19, after developing septic shock and heart function problems. The nose and throat sample turned negative, but the lower respiratory sample tested positive.

Doctors tested a sample they had saved from the donor’s lower airways. He tested positive for the virus.

The patient’s condition continued to worsen over the next few weeks. He experienced multisystem organ failure and developed worsening respiratory impairment. She was treated with the antiviral drug remdesivir and received convalescent plasma on two occasions, but her condition continued to decline.

He 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 then recovered. Ten more members of the transplant team tested negative for the virus.

Genetic screening showed that the surgeon and the transplant recipient were extremely likely to have been infected by the donor’s lungs.

By 2020, nearly 40,000 transplants were performed in the U.S., suggesting that this type of COVID-19 transmission is extremely rare. Non-pulmonary donors (those who donate organs such as kidneys, hearts, and livers) seem unlikely to transmit the virus even if they have it, Kaul said.

However, the case has motivated doctors to ask for more comprehensive evidence from donors.

The organ acquisition and transplant network, which oversees transplants in the U.S., does not require routine COVID-19 donor testing. 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.

In addition, 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 recipient had been negative for COVID-19. The doctors who wrote this study said that these health workers should consider wearing both N95 masks and eye protection even if donors and recipients give negative.