Patient Received COVID-19 Infected Lungs During Transplant, Died: Case Report

A new case report highlights the potential risk of COVID-19 following organ transplants, indicating that a Michigan woman died after receiving an infected lung from a donor who initially tested negative.

This is the first known case of COVID-19 transmission from an organ transplant.

Doctors from the University of Michigan outlined details about the first known case of COVID-19 transmission from an organ transplant in a case report published February 10, in the American Journal of Transplantation.

The Michigan woman, who suffered from chronic obstructive lung disease, had no history of COVID-19 infection and tested negative for the virus. She received the lungs from a donor who died after suffering severe brain injury in a car accident.

The donor tested negative for COVID-19 via nose and throat samples, but did not receive lower respiratory tract testing.

Following the lung transplant surgery, the recipient developed a fever, low blood pressure and difficulty breathing three days after the procedure. Imaging showed signs of lung infection. She later developed septic shock and heart problems. Doctors then conducted COVID-19 testing, which came back positive.

The patient died two months after receiving the double-lung transplant. The donor showed no signs of illness before her death, had no recent travel, did not have COVID symptoms and initially tested negative for coronavirus. Doctors had a sample of deep lung fluid which they then tested for COVID and it tested positive.

One thoracic surgeon present during the transplant procedure who handled the donor lungs also developed COVID-19. Traceback investigations indicate the donor was the origin of the infection for both the organ recipient and the surgeon. No other organs were procured form the donor.

This is the first confirmed case of coronavirus transmission via organ transplant. It is the only confirmed case among nearly 40,000 transplants conducted in 2020; however, other cases have been suspected. The U.S. Centers for Disease Control and Prevention report having reviewed eight possible cases of donor-derived infection, but concluded another source was the cause of the infections.

Researchers emphasize a need for more thorough testing of organ donations, especially lung transplant donors. It is unclear if other organs such as heart or livers can also transmit the virus. Samples should be taken from the nose, throat and deep within the lungs to confirm the presence of the virus, they recommend.

Organs used for transplants have been tested routinely during the pandemic, but it is not mandatory for the testing currently.

Transplant centers and organ procurement organizations should consider extensive donor testing and enhanced personal protective equipment for health care workers involved in lung procurement and transplantation.