Transplant Patient Dies After Getting Covid-Infected Lungs
Monday, February 22, 2021 (Kaiser News) – This story also aired on NBC News. It can be reposted for free.
Doctors say Michigan woman contracted covid-19 and died last fall two months after receiving a contaminated lung transplant from a donor who was found to harbor the virus that caused the disease – although she shows no signs of illness and initially tested negative.
Officials at the University of Michigan School of Medicine have suggested that it may be the first proven case of covid in the United States in which the virus has been transmitted through an organ transplant. A surgeon who manipulated the donor’s lungs was also infected with the virus and became ill but later recovered.
The incident appears to be isolated – the only confirmed case among nearly 40,000 transplants in 2020. But it has led to calls for more extensive testing on lung transplant donors, with samples taken from deep in donors’ lungs as well. than the nose and throat, said Dr. Daniel Kaul, director of Michigan Medicine’s infectious disease transplant service.
“We absolutely would not have used the lungs if we had had a positive covid test,” said Kaul, who co-wrote a report on the case in the American Journal of Transplantation.
The virus was transmitted when the lungs of an Upper Midwestern woman who died of a severe brain injury in a car accident were transplanted into a woman with chronic obstructive pulmonary disease in hospital University of Ann Arbor. Regular nose and throat samples taken from organ donors and recipients have tested negative for SARS-CoV-2, the virus that causes covid.
“All the screening that we do and are able to do normally, we have done it,” Kaul said.
Three days after the operation, however, the recipient developed a fever; her blood pressure dropped and her breathing became difficult. Imaging showed signs of lung infection.
As her condition worsened, the patient developed septic shock and problems with heart function. Doctors decided to test for SARS-CoV-2, Kaul said. Samples from his new lungs came back positive.
Suspicious of the origin of the infection, doctors returned to the samples from the transplant donor. A molecular test of a sample from the donor’s nose and throat, taken 48 hours after acquiring his lungs, was negative for SARS-Cov-2. The donor’s family told doctors they had no history of recent travel or symptoms of covid and no known exposure to anyone with the disease.
But doctors had kept a sample of the washed fluid deep in the donor’s lungs. When they tested this fluid, it was positive for the virus. Four days after the transplant, the surgeon who handled the donor’s lungs and performed the surgery also tested positive. Genetic testing revealed that both the transplant recipient and the surgeon had been infected by the donor. Ten other members of the transplant team tested negative for the virus.
The transplant recipient deteriorated rapidly, developing multisystem organ failure. Doctors have tried known treatments for covid, including remdesivir, a newly approved drug, and recovering blood plasma from people previously infected with the disease. Eventually, she was placed on the last resort option of ECMO, or extracorporeal membrane oxygenation, to no avail. The life support was removed and she died 61 days after the transplant.
Kaul called the incident a “tragic case”.
While the Michigan case marks the first confirmed incident in the United States of transplant transmission, others have been suspected. A recent report from the Centers for Disease Control and Prevention looked at eight possible cases of what is called a donor-derived infection that occurred last spring, but concluded that the most likely source of transmission of the covid virus in these cases was in a community or health care facility.
Prior to this incident, it was not clear whether the covid virus could be transmitted through solid organ transplants, although it is well documented with other respiratory viruses. Donor transmission of the 2009 H1N1 pandemic influenza has been detected almost exclusively in lung transplant recipients, Kaul noted.
While it is not surprising that SARS-CoV-2 can be transmitted from infected lungs, it is not certain that other organs affected by covid – the heart, liver, and kidneys, for example. – can also transmit the virus.
“It seems to non-pulmonary donors that it can be very difficult to pass the covid on, even if the donor has a covid,” Kaul said.
Organ donors have been regularly tested for SARS-CoV-2 during the pandemic, although this is not required by the Organ Procurement and Transplantation Network, or OPTN, which oversees transplants in the United States. of Michigan stresses the need for more comprehensive pre-transplant sampling, especially in areas with high rates of covid transmission, Kaul said.
When it comes to the lungs, that means making sure to test samples from the donor’s lower respiratory tract, as well as the nose and throat. Obtaining and analyzing such samples from donors can be difficult in a timely manner. There is also the risk of introducing an infection into donated lungs, Kaul said.
Since no organs other than the lungs were used, the Michigan case does not provide an overview of testing protocols for other organs.
Overall, viral transmission from organ donors to recipients remains rare, occurring in less than 1% of transplant recipients, according to research. The medical risks faced by sick patients who reject a donor organ are usually much higher, said Dr David Klassen, chief medical officer of the United Network for Organ Sharing, the federal contractor that manages the OPTN.
“The risks of refusing transplants are catastrophic,” he said. “I don’t think patients should be afraid of the transplant process.”
Kaiser Health News (KHN) is a national information service on health policy. This is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
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