Although both the donor and lung recipient tested negative prior to the surgery, subsequent testing confirmed donor-derived infection

By Maria Pasquini
February 22, 2021 12:52 PM
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A Michigan woman died last fall after receiving a double-lung transplant from a donor who was infected with the virus that causes COVID-19, although an initial COVID test prior to the surgery came back negative.

In a new report published earlier this month in the American Journal of Transplantation, officials at the University of Michigan Medical School described a case of "proven transmission" between a donor and recipient — which they believe is the first in the United States. 

While a Centers for Disease Control and Prevention report published earlier this month identified eight possible cases of infections between donors and recipients, it noted that "findings suggest the most likely source of transmission was community or healthcare exposure." 

Michigan doctors say in this case, the virus was transmitted from the lungs of a woman who died after suffering severe brain injury in a car accident. Testing performed within 24 hours of procuring the lungs yielded a negative result and the woman had no recent history of travel or any symptoms commonly associated with COVID-19. 

The transplant recipient, who had chronic obstructive lung disease, also tested negative 12 hours before the procedure.

"We would absolutely not have used the lungs if we'd had a positive Covid test," lead author Dr. Daniel Kaul, director of Michigan Medicine's transplant infectious disease service, told NBC News

Three days after the surgery, the lung recipient developed a fever and low blood pressure. Additionally, imaging performed on her lungs showed signs of infection. 

As her symptoms worsened, she developed septic shock, which is atypical, leading doctors to test for COVID-19. After the tests came back positive, doctors tested samples from the donor, which also came back positive.  

As the lung recipient's health condition continued to deteriorate, she suffered multi-system organ failure and had to be put on a ventilator. She died 61 days after the surgery was performed.

Testing performed the day before she died indicated she was still infected with COVID-19.

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Four days after the transplant, the thoracic surgeon who performed the surgery also tested positive for COVID-19. The surgeon went on to recover and no additional health care workers present during the course of the transplant fell ill.

Subsequent testing confirmed that the donor was the origin of both cases of infection. No other organs were obtained from the donor. 

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Although overall rates of infection transmission from donor to recipient occur in fewer than 1 percent of cases, the authors of the study are calling for transplant centers and organ procurement organizations to test all lung donors for SARS-CoV-2.

Additionally, authors are suggesting that all healthcare workers involved with lung transplant surgeries should consider using N95 masks and eye protection during surgeries, even in instances where donors tested negative.

Despite the confirmed case of donor-derived infection, health officials are urging patients in need of a transplant not to get frightened.  

"The risks of turning down transplants are catastrophic," Dr. David Klassen, chief medical officer with the United Network for Organ Sharing, told NBC News. "I don't think patients should be afraid of the transplant process."

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