A woman in Michigan died 61 days after receiving a pair of lungs from an organ donor who was infected with a coronavirus, according to a case report released this month.
There is no indication that the donor, a woman fatally injured in a car accident, had Covid-19. The chest X-ray seemed clear, and the coronavirus nasal swab test was negative.
But doctors who worked with the pulmonary receiver at Ann Arbor University Hospital in Michigan last fall began questioning those results when their patient’s condition worsened. They concluded that the donor did have Covid-1
This is the first confirmed case of a patient infecting a patient from a donor organ, according to the authors of a peer-reviewed report published in The American Journal of Transplantation on February 10.
“We want the transplant community to be aware that this can happen, and that there may be things we can do to improve our success in screening patients for Covid,” said surgeon Dr. Jules Lynn, author. of the report and the surgical director of the lung transplant program in Michigan medicine, the health system of the University of Michigan.
The report says that health professionals should consider testing lung donors for coronavirus using a sample from their lower airways that extends into the lungs beyond the reach of a nasal swab. This type of testing, which is invasive and not recommended to the general public, is not always available; currently only about a third of donated lungs are tested this way.
Dr David Klassen, chief medical officer at the United Organ Sharing Network, the NGO that runs the national organ transplant system, said the Michigan case was “very important”, although rare.
“We want to minimize any chances of this happening again,” he said.
Every organ donor in the United States has been tested for coronavirus in some way, Dr. Klassen said. The tests are not performed by transplant surgeons; Instead, they are typically observed by nonprofit groups known as public procurement organizations operating in the United States.
The Organ Procurement Association has asked questions about the gift of life Michigan, which is not involved in the case. Its chief clinical officer, Bruce Nisley, said many laboratories refused to take samples from the lower lungs at the start of the pandemic, fearing the procedure could contribute to the spread of the coronavirus.
“In response to the recommendations of the study, we are all in favor of recommendations that improve safety and reduce the risk of infection,” said Mr. Nicely, adding that his organization has found a laboratory partner who is able to test the lower respiratory tract. tract.
When organs become available, time is of the essence. Some health facilities do not have the resources to quickly test the lower respiratory tract of donors for Covid-19. Given these limitations, there is no requirement for lung donors to be tested in this way.
“We could assign it,” Dr. Klassen said. “But this can have the effect of severely restricting the lungs, which can be used for transplantation.”
Of the nearly 40,000 organ transplants performed in the United States last year, surgery in Michigan is the only confirmed case of a recipient infecting a coronavirus from a donor.
“It’s important to emphasize that this is fortunately a rare event,” said Dr. Daniel R. Kaul, author of the study and an infectious disease specialist in Michigan medicine. The case, he said, should not discourage people from receiving transplants that could save their lives.
He added that the recipient of the organ, who suffered from chronic obstructive pulmonary disease, appeared to have had successful surgery until her condition worsened a few days later.
“Suddenly she had a fever, low blood pressure, pneumonia,” Dr. Kaul said. “I wasn’t sure what was going on.”
When further tests showed that the woman had Covid-19, doctors sought a lung donor. Her nasal swab test was negative before the transplant, but these tests did not capture everything. The doctors had to find a way to test the donor again.
As it turned out, they had exactly what they needed: a sample of the deceased woman’s lower airway. Michigan medicine regularly collects such samples from lung donors to test them – not for Covid-19, but for ureaplasma, bacteria that can cause a rare syndrome.
Doctors found that they still had enough of the donor’s sample to test for the coronavirus. The result showed that the donor was indeed infected with the virus, and the analysis of the gene sequence showed that the patient had contracted the virus from the donor’s lungs.
So was Dr. Lynn, who wore a surgical mask during the transplant operation. (The report he co-authored recommended that transplant centers consider the benefits of wearing N95 masks throughout the lengthy procedure, even if the donor tested negative for coronavirus.) He spent several weeks recovering from the infection at home, he said. adding that the infection had not spread to his colleagues or family members.
The patient, vulnerable after major surgery, did not recover despite attempts by doctors to save her with a series of treatments, including convalescent plasma, steroids and remdezivir. Doctors now hope her case report will persuade more medical professionals to tighten their standards for testing coronavirus for organ donors, despite logistical difficulties.
“I think these are barriers we need to work on to overcome them,” Dr. Lynn said, “for the safety of our patients.”