A woman in Michigan died 61 days after receiving a pair of lungs from an organ donor infected with the coronavirus, according to a case report published this month.
There was no evidence that the donor, a woman fatally injured in a car accident, had Covid-19. An X-ray of her chest had appeared clear and a nasal swab for the coronavirus had shown a negative result.
But the doctors who worked with the lung receiver at University Hospital in Ann Arbor, Michigan last fall, began to question those results when their patient’s condition deteriorated. They concluded that the donor did indeed have Covid-19 – and that her lungs had infected not only the transplant patient, but also the surgeon.
It 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 Feb. 10 in The American Journal of Transplantation.
“We want the transplant community to be aware that this can happen, and also that there can be things we can do to improve our success in screening patients for Covid,” said the surgeon, Dr. Jules Lin, an author of the report and the surgical director of the lung transplant program at Michigan Medicine, the University of Michigan health system.
The report said medical professionals should consider testing lung donors for the coronavirus using a sample from their lower airways, which extends into the lungs – beyond the reach of a nasal swab. That kind of testing, which is invasive and not recommended for the general public, is not always available; currently only about a third of donated lungs are tested in this way.
Dr. David Klassen, the chief medical officer at the United Network for Organ Sharing, the nonprofit that manages the national organ transplant system, said the Michigan case was “highly significant” despite its rarity.
“We want to minimize the chance of recurrence,” he said.
Every organ donor in the United States is being tested for the coronavirus in one way or another, said Dr. Klassen. The tests are not performed by transplant surgeons; instead, they are usually overseen by nonprofit organizations known as organ procurement organizations operating in the United States.
The Association of Organ Procurement Organizations referred inquiries to Gift of Life Michigan, which was not involved in this case. Chief clinical officer Bruce Nicely said many labs had refused to take samples from the lower lungs early in 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 improve safety and reduce the risk of infection,” said Mr. Nicely, adding that his organization has found a lab partner capable of performing tests on the lower respiratory tract. tract.
When organs become available, time is of the essence. Some health facilities do not have the resources to quickly test donors’ lower airways for Covid-19. Given these limitations, there is no requirement that lung donors be tested in this manner.
“We could make it mandatory,” said Dr. Classes. “But that could have the downstream effect of severely limiting the lungs that can be used for transplantation.”
Of the nearly 40,000 organ transplants performed in the United States last year, the Michigan surgery was the only confirmed case of a recipient contracting the coronavirus from a donor.
“It’s important to emphasize that fortunately this is a rare event,” said Dr. Daniel R. Kaul, an author of the study and infectious disease specialist at Michigan Medicine. The case, he said, shouldn’t stop people from getting transplants that could save their lives.
He added that the organ recipient, who suffered from chronic obstructive pulmonary disease, appeared to have had successful surgery until her condition deteriorated 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 investigation revealed that the woman had Covid-19, the doctors looked at the lung donor. Her nose swab was negative for the transplant, but those tests don’t catch everything. The doctors had to find a way to retest the donor.
As 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.
The doctors found they still had enough of the donor’s sample to test for the coronavirus. The result showed that the donor was indeed infected with the virus, and gene sequence analysis showed that the patient had contracted the virus from the donor’s lungs.
So did 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 hours-long procedure, even if the donor tested negative for the 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 relatives.
The patient, vulnerable after major surgery, did not recover despite doctors’ efforts to save her with a range of treatments, including restorative plasma, steroids, and remdesivir. The doctors now hope her case report will convince more medical professionals to bolster their coronavirus testing standards for organ donors, despite the logistical issues.
“I think these are barriers we have to work to overcome,” said Dr. Lin, “For the safety of our patients.”