A woman died at Michigan Medicine Wednesday 61 days after unknowingly receiving a lung transplant in the fall from an organ donor infected with the coronavirus. The Michigan resident was the first confirmed case of someone contracting the virus from an organ donor.
The donor’s lungs infected both the recipient and the surgeon. Prior to the transplant, there was no sign that the donor — who died in a car crash — had the virus: she tested negative for COVID-19 in a post-mortem nasal swab, and a post-mortem radiograph of the donor’s chest also cleared her of the virus.
Hospitals vary widely in how they test the donors. Tests are usually performed by nonprofit groups — known as organ procurement organizations— rather than the transplant surgeons themselves.
According to a case report published earlier this month, medical professionals should carefully consider testing the lower respiratory tract of lung donors for COVID-19 — a process that is invasive and not widely done, but could yield more accurate results about whether a donor is infected. Bruce Nicely, chief clinical officer of Gift of Life Michigan, told the New York Times that labs did not swab the lower lungs early in the pandemic because they were worried the process itself could possibly spread COVID-19.
Testing the lower respiratory tract for COVID-19 also takes a significant amount of time — time which patients who are desperately in need of a transplant may not have. For these reasons, donors are not required to undergo this test before a recipient receives the organ.
However, before transplants, Michigan Medicine does use a specimen from the lower respiratory tract to check lung donors for ureaplasma, a bacteria that can cause a rare syndrome. After the recipient fell ill, this leftover sample gave Michigan Medicine doctors the specimen they needed to test for COVID-19 and determine that the recipient died after becoming infected by the donor’s lungs. A gene-sequence analysis done by the hospital confirmed this result.
The patient did not recover from doctors’ numerous attempts to save her with various treatments, including convalescent plasma, steroids and remdesivir, the only antiviral medicine approved by the U.S. Food and Drug Administration for treating COVID-19 patients.
Dr. David Klassen, the chief medical officer at the United Network for Organ Sharing, told the New York Times this case was “very significant” despite being rare. Klassen said he hopes this case will encourage medical professionals to tighten COVID-19 testing standards for organ donors.
“We want to minimize any chances of this reoccurring,” Klassen said.
Dr. Daniel Kaul, an infectious disease doctor at Michigan Medicine, saw the patient a couple days after the transplant. Kaul told The Michigan Daily in an interview that this was a very isolated occurrence and should not diminish trust in the transplant process. According to Kaul, organ procurement organizations should perform more thorough tests within the lungs before approving them for transplantation in the future.
“It’s important that people who are in need of an organ, or have organ failure or are in need of an organ transplant, recognize that this is a very, very low risk situation,” Kaul said. “This hasn’t been reported before. And it may not even be a risk for organs that aren’t lungs. It shouldn’t make people afraid to get a transplant if that’s what they need.”
Daily Staff Reporter Julia Forrest can be reached at juforres@umich.edu.
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