A lung transplant procedure last fall in Michigan resulted in the death of the patient and illness of a surgeon involved from COVID-19, after both the donor and recipient initially tested negative. Doctors say this is the first documented case of a transplant recipient contracting the virus from a donor.
The lung donor was a woman from the upper midwest, according to the doctors, and had suffered a severe brain injury in a car accident in November. She quickly advanced to “brain death,” according to the report published recently, and she was tested for COVID-19 before her organs were donated.
Her family said she showed no signs of COVID-19 symptoms in the days before the accident, and had no history of travel.
“We would absolutely not have used the lungs if we’d had a positive Covid test,” Dr. Daniel Kaul, who co-authored the report in the American Journal of Transplantation detailing the case, and the director of Mighigan Mediciden's transplant infectious disease service told NBC News.
The recipient had chronic obstructive lung disease, and was tested for COVID-19 before the transplantation at University Hospital in Ann Arbor.
“All the screening that we normally do and are able to do, we did,” Kaul said.
Three days after the procedure, the recipient spiked a fever, her blood pressure fell and it became hard for her to breathe. Images of her new lungs showed signs of infection.
Test samples from her new lungs came back positive for COVID-19.
Four days after the procedure, the surgeon who had handled the donor’s lungs tested positive for COVID-19.
Looking for answers, doctors returned to samples taken from the donor. A test taken 48 hours after the lungs were procured had been negative for COVID-19. However, they were able to test a sample taken from deep within the donor’s lungs. That sample came back positive.
Genetic testing showed the surgeon and recipient had been infected by the donor.
The transplant recipient’s condition worsened, and 61 days after the lung transplant procedure, she died.
The surgeon has recovered.
While doctors involved in studying this incident say this is the first confirmed case of COVID-19 transmission from an organ transplant, other cases have been suspected.
The CDC recently looked at eight incidents from early on in the pandemic, however they determined the most likely source of the infection was exposure in the community or health care setting.
The doctors who wrote the report, from the University of Michigan, are calling for caution and more testing during transplantations.
“Transplant centers and organ procurement organizations should perform SARS-CoV-2 testing of lower respiratory tract specimens from potential lung donors, and consider enhanced personal protective equipment for health care workers involved in lung procurement and transplantation,” the report’s authors state.
They also noted that because both the donor and recipient had tested negative for COVID-19, following accepted protocol, the health care workers involved in the procedure were not required to wear N95 masks and eye protection as part of their PPE.
The study encourages transplant centers to consider the benefits of N95 masks and eye protection during transplantation, even with negative COVID-19 tests.
No other organs from the donor were used.