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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 has been published.
“To my knowledge, this is the first, and in fact the only, documented transfer of COVID-19 to a recipient” of donated organs, “said Bruce Nicely, chief clinical officer of Gift of Life Michigan, the federally designated organ and tissue repair, said. program.
The case is rare and represents “the worst case scenario” to play out in a pandemic that killed half a million Americans, Nicely said, pointing out 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 case reports that 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.
The organ donor, a Middle Eastern woman who suffered brain death after a car accident, also underwent a negative PCR test using a nasopharyngeal swab within 48 hours of her organs being obtained.
The donor’s family reported that she had no history of travel and that she had no recent COVID-19 symptoms. It was unclear whether the organ donor was exposed to a person infected with the virus.
“By definition, that donor was asymptomatic,” says Dr. Daniel Kaul, who is the director of the transplant service at the University of Michigan and was among the authors of the study. ‘But it is important to recognize that the donor was tested with a standard PCR and was negative, and the test was repeated on the same sample and again negative.
“In most asymptomatic carriers, the vast majority – more than 90% – would be positive.”
One day after the transplant, the recipient’s heart did not pump as efficiently as expected, and two days after the transplant, he developed a fever, low blood pressure, and shortness of breath.
Doctors collected samples of fluid from her lungs using a bronchoalveolar rinse and tested the fluid on SARS-CoV-2. The results were positive.
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The same type of fluid from the organ donor was also tested on coronavirus, and also yielded a positive result.
Shortly thereafter, a breast surgeon who performed the transplant also tested positive for the virus. The order of the entire 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 underwent the double lung transplant was treated at the hospital for COVID-19 and was given the antiviral medication as well as steroids, but her condition worsened. She died about two months after her transplant surgery.
The issue is a dilemma for transplant doctors: people who need organ transplants are at high risk of dying without it, but there is no way to definitively prove that an organ donor may not carry a disease like COVID-19.
“You can not 100% prove that someone does not have something, because we do not have perfect tests,” Kaul said. ‘We are therefore trying to compile a combination of their exposure, their clinical history, testing, radiology such as a CT scan of the donor’s lung, which has been done and shows nothing that looks like COVID.
“We do all these things and say, ‘Well, as best we can determine, this donor is safe to use.’ But unfortunately in this case there was an asymptomatic COVID that was not detected by the standard test. ‘
Kaul suggested that organ procurement organizations use lung fluid samples to test COVID-19 before transplantation. Nicely of Gift of Life Michigan said Monday that the organization is making the standard procedure for lung donations.
In this case, no other organs of the donor were used for transplantation.
The authors of the study warned that this case could not be used to indicate that there is a risk of coronavirus infection when other organs, such as kidneys, liver, heart or pancreas, can occur during transplantation.
“In the spring, the number of transplants in affected areas, such as southeastern Michigan, has dropped dramatically,” Kaul said.
There were concerns about whether transplants could be done safely if the virus was so widespread, he said, and whether hospitals had the staff and means to perform transplants when they were inundated with critically ill COVID-19 patients.
” Part of that was the concern about what would happen to someone immediately after the transplant who would get COVID and how to best investigate donors, ” he said.
“I have no doubt that there were other donors who had COVID, whose organs were used but the recipients did not become ill, and this may be because organs other than the lungs were used. It is possible that there were other cases was true was a transfer and bad outcomes, but it was not obvious and no one tested for it. ‘
This case, according to him, is incredibly rare.
“I do not think that people who have organ failure who need organ transplants should be afraid of COVID with the organ transplant,” Kaul said. ‘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 an organ declining when presented is far greater than the risk of transmitting this virus through other donors or other infections that we try to find, but which do not always can not occur.
Nicely put, a death like this after transplantation is doubly devastating.
“Our heart goes out to the family of the recipient as well as the family of the donor,” Nicely said. ‘When the recipient of donated organs dies, it is sometimes a double tragedy for the donor family.
“The case was certainly one of the major challenges for donation and transplantation at the time of a pandemic. It is being tested, and there is the fact that the 110,000 people on the waiting list are not getting a break for their end organ. not a break just because there is a pandemic.Their disease still takes its toll.They stay on the waiting list.
“Donation does save lives,” he said. “It really matters. So, despite a pandemic. The need and opportunity to do good remains.”
Contact Kristen Shamus: [email protected]. Follow her on Twitter @kristenshamus.