A woman who died after undergoing a double lung transplant at the University of Michigan Medical School in Ann Arbor is the first known person to contract COVID-19 from donor lungs, according to a new case report published in the American Journal of Transplantation.
"To my knowledge, this is the first, and actually the only, documented transmission of COVID-19 to a recipient" from donated organs, said Bruce Nicely, chief clinical officer of Gift of Life Michigan, the state's federally designated organ and tissue recovery program.
The case represents "the worst-possible scenario" to play out in the pandemic that has killed more than half a million Americans, Nicely said, noting, however, that Gift of Life Michigan was not involved in this donation. The transplant occurred in late October and the donor was from out of state.
The woman who underwent the double lung transplant had chronic obstructive pulmonary disease, and tested negative for coronavirus using a rapid polymerase chain reaction (PCR) test 12 hours prior to surgery, the case report details.
The organ donor, a woman from the Upper Midwest who suffered brain death following an auto accident, also had a negative PCR test using a nasopharyngeal swab within 48 hours of when her organs were procured.
The donor's family reported that she had no known history of travel and didn't have any recent COVID-19 symptoms. It was unclear whether the organ donor had exposure to a person infected with the virus.
A day after the transplant, the recipient's heart wasn't 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 her lungs using what's known as a bronchoalveolar lavage, and tested that fluid for SARS-CoV-2. The results were positive.
The same type of fluid from the organ donor was then also tested for coronavirus, and also yielded a positive result.
Soon after, a thoracic surgeon who performed the transplant surgery also tested positive for the virus. Whole genome sequencing of all three people showed that the disease likely originated in the organ donor, and spread to the recipient and the surgeon during transplantation.