A woman from Michigan, US, has died after receiving a double-lung transplant that was infected with SARS-CoV-2, states a new case report to the American Journal of Transplantation. Despite the organs testing negative for the virus, the woman became infected with acute COVID-19 three days after transplantation, representing the first case of proven donor-to-recipient transmission.
The recipient was not the only one to fall ill to the infected lungs – a surgeon who prepared the lungs fell ill soon after reporting potential exposure to infected mucus but recovered soon after.
Whilst tragic, these incidents are extremely rare. Donor-to-recipient transmission of infections occurs in less than 1% of all transplantations, with strict preparation and testing ensuring only healthy organs continue to surgery.
The recipient of the lungs was a woman admitted to the hospital with chronic obstructive lung disease. They were on mechanical ventilation and required a double-lung transplant, which was ‘uncomplicated’ according to the authors. Following standard transplantation procedures, the patient was immunosuppressed with the drug methylprednisolone to prevent organ rejection.
She was to receive a pair of lungs from a recently-deceased woman for the upper Midwest, who was involved in a traffic collision and died in hospital shortly after. A swab test for COVID-19 flagged no signs of infection, nor did the donor report any symptoms prior to her death.
Just 2 days after transplantation, the doctors noticed something wrong with the patient. She had a low cardiac index (a measurement of the heart’s performance in relation to body size) and developed a fever on day 3. After samples were sent for testing, the woman tested positive for COVID-19.
Despite attempts at combatting the virus with remdesivir, the woman’s condition continued to worsen and on day 61 post-transplantation, she died following multi-system organ failure and respiratory distress.
This case remains the first incident reported, but one that acts as a powerful message that extensive testing is required for transplant organs. The authors state that one test may not be enough to ensure organs are fully free from SARS-CoV-2, and a second test may be needed.
“Laboratory testing for non-lung donors should include at least one sample from the respiratory tract, and consideration for a second sample obtained within 24-48 hours of procurement.” they write.
However, prospective organ recipients should not be afraid of a transplant. Speaking to NBC News, Dr Daniel Kaul, director of Michigan Medicine’s transplant infectious disease service and co-author of the case report, says the need for transplants far outweighs any risks.
“The risks of turning down transplants are catastrophic,” he said. “I don’t think patients should be afraid of the transplant process.”