Woman who died after transplant received COVID-19 from donated lungs

Kristen Jordan Shamus

| Detroit Free Press


A woman who died after undergoing a double lung transplant at the University of Michigan School of Medicine in Ann Arbor is the first known person to contract COVID-19 from donor lungs, according to a new published case report. in the American Journal of Transplantation.

“To my knowledge, this is the first, and indeed the only, documented transmission of COVID-19 to a recipient” of donated organs, said Bruce Nicely, clinical director of Gift of Life Michigan, the organ and tissue recovery agency. designated by the federal government. Program.

The case is rare and represents “the worst possible scenario” in a pandemic that has killed half a million Americans, Nicely said, noting, however, that Gift of Life Michigan was not involved in this donation. The transplant took place in late October and the donor was from another state.

The woman who underwent the double lung transplant had chronic obstructive pulmonary disease and tested negative for coronavirus by rapid polymerase chain reaction (PCR) test 12 hours before surgery, the case report details.

The organ donor, a woman from the Upper Midwest who suffered brain death after a car accident, also had a negative PCR test using a nasopharyngeal swab within 48 hours of obtaining her organs.

The donor’s family reported that she had no known travel history and did not have any recent symptoms of COVID-19. It was not clear if the organ donor was exposed to a person infected with the virus.

“By definition, that donor was asymptomatic,” said Dr. Daniel Kaul, director of the Transplant Infectious Diseases Service at the University of Michigan and one of the study authors. “But it’s important to recognize that the donor was tested with a standard PCR and was negative, and that test was repeated on the same sample, and it came back negative.

“In the majority of asymptomatic carriers, the vast majority – more than 90% – would test positive.”

One day after the transplant, the recipient’s heart was not pumping as efficiently as expected, and two days after the transplant, she developed a fever, low blood pressure, and respiratory distress.

Doctors collected samples of fluid from his lungs using what’s known as bronchoalveolar lavage and tested that fluid for SARS-CoV-2. The results were positive.

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The same type of fluid from the organ donor was also tested for coronavirus and also tested positive.

Soon after, a thoracic surgeon who performed the transplant surgery also tested positive for the virus. Whole genome sequencing of the three people showed that the disease likely originated in the organ donor and spread to the recipient and surgeon during transplantation.

The woman who underwent the double lung transplant was treated for COVID-19 at the hospital and received the antiviral drug remdesivr and convalescent plasma, as well as steroids, but her condition worsened. He died about two months after his transplant surgery.

The case poses a dilemma for transplant doctors: People who need organ transplants are at high risk of dying without them, but there is no way to definitively prove that an organ donor might not be a carrier of a disease like COVID-19. .

“You can’t prove 100% that someone doesn’t have something because we don’t have perfect proof,” Kaul said. “So we tried to put together a combination of his exposures, his medical history, tests, radiology like a CT scan of the donor’s lung, which was done and showed nothing that looked like COVID.

“We do all of those things and say, ‘Well, to the best of our ability, this donor is safe to use.’ But unfortunately, in this case, there was asymptomatic COVID that was not detected by standard tests. “

Kaul suggested that organ procurement organizations should use lung fluid samples to test for COVID-19 before transplantation. Nicely of Gift of Life Michigan said Monday that the organization is in the process of going through that standard procedure for lung donations.

In this case, no other donor organs were used for transplantation.

The study authors cautioned that this case cannot be used to suggest that there is a risk of coronavirus infection when other organs, such as the kidneys, liver, heart or pancreas, may present in transplantation.

“In the spring, the number of transplants in badly affected areas like southeast Michigan really dropped dramatically,” Kaul said.

There were concerns about whether transplants could be safely performed when the virus was so widespread, he said, and about whether hospitals had the staff and resources to perform transplants when they were inundated with critically ill COVID-19 patients.

“In part it was due to concerns about what would happen to someone immediately after transplantation who could get COVID and how best to screen donors,” he said.

“I have no doubt that there have been other donors who had COVID whose organs were used but the recipients did not get sick, and that may be because organs other than the lungs were used. There may have been other cases where there have been been the transmission and the bad results, but it was not obvious and nobody tested it. “

This case, he said, is incredibly rare.

“I don’t think that people with organ failure who need organ transplants should be afraid of getting COVID from organ transplantation,” Kaul said. “That’s the good news and if you have organ failure, there are a lot of bad things that can happen to you because of it … For the vast majority of people, the risk of rejecting an organ when offered is much greater than the risk of transmission. of the donor of this virus or other infections that we try to find, but not always. “

Well said, a death like this after a transplant is doubly devastating.

“Our hearts go out to the recipient’s family and to the donor’s family,” Nicely said. “If the recipient of the donated organs dies, it is also sometimes a kind of double tragedy for the donor’s family.

“That case undoubtedly represented one of the great challenges for donation and transplantation in the era of a pandemic. There is evidence and there is the fact that those 110,000 people on the waiting list do not have a break in their end-stage organ. They do not pause just because there is a pandemic Their illness continues to take its toll They remain on the waiting list.

“Donating saves lives,” he said. “It really matters. So, despite a pandemic. The need and the possibility to do good remain.”

Contact Kristen Shamus: [email protected] Follow her on Twitter @kristenshamus.

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