Transplant Affected person Dies After Receiving Lungs Contaminated With Coronavirus

A Michigan woman died 61 days after receiving a pair of lungs from an organ donor infected with the coronavirus. This came out from a case report published this month.

There was no evidence that the donor, a woman who was fatally injured in a car accident, had Covid-19. An X-ray of her chest appeared clear and a nasal swab test for the coronavirus had given a negative result.

But doctors who worked with the lung recipient at the University Medical Center in Ann Arbor, Michigan last fall began to question these results when their patient’s condition worsened. They concluded that the donor did indeed have Covid-19 – and that her lungs infected not only the transplant patient, but the surgeon as well.

This was the first confirmed case of a patient contracting the virus from the patient’s organ donor, according to the authors of the peer-reviewed report published February 10 in the American Journal of Transplantation.

“We want the transplant community to know that this can happen and that we may be able to take steps to improve our success in screening patients for Covid,” said surgeon Dr. Jules Lin, author of the report and the surgical director of the lung transplant program at Michigan Medicine, the University of Michigan’s healthcare system.

The report said medical professionals should consider testing lung donors for coronavirus using a sample from their lower airways that extends into their lungs – out of the reach of a nasal swab. These type of tests, which are invasive and not recommended to the public, are not always available. Currently, only about a third of donated lungs are tested this way.

Dr. David Klassen, chief medical officer of the United Network for Organ Sharing, the nonprofit that administers the country’s organ transplant system, said the Michigan case was “very significant” despite its rarity.

“We want to minimize the chance of a recurrence,” he said.

Every organ donor in the United States is tested for the coronavirus in some way, said Dr. Classes. The tests are not performed by transplant surgeons. Instead, they are usually overseen by nonprofit groups known as organ procurement organizations that operate in the United States.

The Association of Organ Procurement Organizations referred questions to Gift of Life Michigan, which were not involved in this case. The chief clinical officer, Bruce Nicely, said many laboratories refused to take samples from the lower lungs at the start of the pandemic, fearing the procedure could contribute to the spread of the coronavirus.

“In response to the study’s recommendations, we are all in favor of recommendations that will improve safety and reduce the risk of infection,” said Nicely, adding that his organization has found a laboratory partner who is able to perform lower respiratory tract tests .

Updated

Apr. 24, 2021, 1:20 p.m. ET

When organs become available, time is of the essence. Some healthcare facilities do not have the resources to quickly test donors’ lower respiratory tract for Covid-19. Given these limitations, there is no need to test lung donors in this way.

“We could hire it,” said Dr. Classes. “But that could have the downstream effect of severely restricting the lungs that could be used for the transplant.”

Of the nearly 40,000 organ transplants performed in the United States last year, the Michigan surgery was the only confirmed instance of a recipient contracting the coronavirus from a donor.

“It is important to emphasize that fortunately this is a rare occurrence,” said Dr. Daniel R. Kaul, study author and infectious disease specialist at Michigan Medicine. The case, he said, shouldn’t prevent people from receiving transplants that could save their lives.

He added that the organ recipient, who had chronic obstructive pulmonary disease, appeared to have had surgery successfully until her condition worsened a few days later.

“Suddenly she had a fever, low blood pressure, pneumonia,” said Dr. Kaul. “I wasn’t sure what was going on.”

When further tests showed that the woman had Covid-19, the doctors looked at the lung donor. Her nasal swab test was negative before the transplant, but these tests don’t capture everything. Doctors had to find a way to retest the donor.

It turned out they had exactly what they needed: a specimen from the deceased woman’s lower respiratory tract. Michigan Medicine regularly collects such samples from lung donors for testing – not for Covid-19 but for ureaplasma, bacteria that can cause a rare syndrome.

Doctors found that they still had enough of the donor sample to test for the coronavirus. The result showed that the donor was indeed infected with the virus, and the gene sequence analysis showed that the patient had infected the virus from the donor’s lungs.

So does Dr. Lin, who wore a surgical mask during the transplant. (The report he co-wrote recommends that transplant centers consider the benefits of wearing N95 masks throughout the procedure, even if the donor tested negative for the coronavirus.) He spent a few weeks getting away from the home Recovering infection, he said, adding that the infection had not spread to his colleagues or family members.

The patient, who was vulnerable after major surgery, recovered despite attempts by doctors to save her with a range of treatments, including convalescent plasma, steroids, and remdesivir. Doctors now hope their case report will convince more medical professionals to improve their coronavirus testing standards for organ donors despite the logistical difficulties.

“I think these are obstacles that we need to work to overcome,” said Dr. Lin, “for the safety of our patients.”

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