A woman in Michigan died 61 days after receiving a pair of lungs from an organ donor who had been infected with coronavirus, according to a case report released 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 breast appeared clear and a nasal inoculation test for coronavirus had returned a negative result.
But doctors working with the lung recipient at University Hospital in Ann Arbor, Mich., Last fall began to question those findings as their patient’s condition worsened. They concluded that the donor actually had Covid-1
It was the first confirmed case of a patient getting the virus from the patient’s organ donor, according to the authors of the peer-reviewed report published in The American Journal of Transplantation on February 10.
“We want the transplant community to be aware that this can happen and also that there may be things we can do to improve our success in screening patients for Covid,” said surgeon Dr. Jules Lin, author of the report and surgical director of the Lung Transplant Program at Michigan Medicine, the health care system at the University of Michigan.
The report said medical professionals should consider testing lung donors for coronavirus using a sample from their lower respiratory tract that extends into the lungs – out of reach of a nostril. The kind of test that is invasive and not recommended to the public is not always available; currently only approx. one third of the donated lungs in this way.
Dr. David Klassen, chief physician at United Network for Organ Sharing, the nonprofit organization that manages the country’s organ transplant system, said the case in Michigan was “very important” despite its rarity.
“We want to minimize any chance of this happening again,” he said.
Every organ donor in the United States is tested for coronavirus in one way or another, said Dr. The class. The tests are not performed by transplant surgeons; instead, they are typically overseen by nonprofit groups known as organ procurement organizations operating throughout the United States.
The Association of Organ Procurement Organizations referred questions to Gift of Life Michigan, which were not involved in this case. Its clinical director, Bruce Nicely, said many laboratories had refused to run samples from the lower lungs early in the pandemic, fearing the procedure could contribute to the spread of coronavirus.
“In response to the study’s recommendations, we are all in favor of recommendations that improve safety and reduce the risk of infection,” Nicely said, adding that his organization has found a laboratory partner capable of performing lower respiratory tract tests.
When organs become available, time is of the essence. Some healthcare facilities do not have the resources to quickly test donors’ lower airways for Covid-19. Given these limitations, there is no requirement for lung donors to be tested in this way.
“We could mandate it,” said Dr. The class. “But it can have the subsequent effect of severely restricting the lungs that can be used for transplantation.”
Of the nearly 40,000 organ transplants performed in the United States last year, surgery in Michigan was the only confirmed occurrence of a recipient contracting coronavirus from a donor.
“It is important to emphasize that this is fortunately a rare event,” said Dr. Daniel R. Kaul, an author of the study and a specialist in infectious diseases at Michigan Medicine. The case, he said, should not deter people from getting transplants that could save their lives.
He added that the organ recipient, who had suffered from chronic obstructive pulmonary disease, appeared to have had a successful operation until her condition worsened a few days later.
“Suddenly she had a fever, low blood pressure, pneumonia,” said Dr. Kaul. “I was not sure what was going on.”
When further tests showed that the woman had Covid-19, the doctors looked at the lung donor. Her nose stick test had come back negative before the transplant, but these tests do not capture everything. The doctors needed to find a way to test the donor again.
As it turned out, they had exactly what they needed: a copy of the deceased woman’s lower respiratory tract. Michigan Medicine regularly collects such samples from lung donors to test them – 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 coronavirus. The result showed that the donor had actually been infected with the virus, and gene sequence analysis showed that the patient had contracted the virus from the donor’s lungs.
Dr. did the same. Linen that had had a surgical mask during the transplant. (The report he wrote together recommends that transplant centers consider the benefits of wearing N95 masks through the hour-long procedure, even though the donor has tested negative for coronavirus.) He spent a few weeks recovering from the infection at home, he said, adding , that the infection had not spread to his colleagues or his family members.
The patient, who was vulnerable in the wake of a major operation, did not recover despite doctors’ attempts to save her with a range of treatments, including convalescent plasma, steroids and strapsivir. Doctors now hope her case report will persuade more medical professionals to strengthen their coronavirus test standards for organ donors despite the logistical difficulties.
“I think these are barriers that we need to work on to overcome,” said Dr. Lin, “for the safety of our patients.”