A woman who received a double lung transplant in October 2020 exhibited severe symptoms of COVID-19 within three days of surgery. She tested negative for coronavirus via nasal swab, but then doctors determined the origin of what turned out to be an ultimately fatal COVID-19 infection: The donor lungs from her organ transplant.
The case, detailed in an article published in the American Journal of Transplantation on Feb. 10, highlights a worst-case scenario as well as “a novel new path for the virus”—though the doctor who oversaw the case emphasizes that there’s a low chance for transmission through this unusual route.
The Washington Post quoted the journal article’s author, Dr. Daniel Kaul, noting, “This is at least the first proven case of transmission of COVID-19 via organ transplantation in the United States.”
Kaul also pointed out that his report should not discourage anyone from considering a transplant, but rather, points to the need for more testing to prevent a repeat of what happened in his case at the University of Michigan Medical School in Ann Arbor.
According to the Post’s account, the woman who received the transplant had chronic obstructive pulmonary disease. She matched with the donor, who suffered a severe car accident and was brain dead. The double lung transplant took place, with the donor testing negative for COVID 48 hours prior to the procedure and the recipient testing negative 12 hours prior to the procedure.
But after just three days post-transplant, she had a fever and difficulty breathing, and scans of her new lungs showed signs of pneumonia—all symptoms consistent with a COVID-19 diagnosis.
USA Today added that the transplant recipient was treated for COVID-19 in the hospital, given the anti-viral medicine Remdesivir as well as convalescent plasma and steroids, but she didn’t recover and died about two months after her transplant surgery.
As that article commented, “The case poses a dilemma for transplant doctors: People who need organ transplants are at high risk for dying without them, but there’s no way to definitively prove an organ donor might not be carrying a disease like COVID-19.”
“You can’t 100% prove that someone doesn’t have something because we don’t have perfect tests,” Kaul told USA Today. “So we try and put together a combination of their exposures, their clinical history, testing, radiology like a CT-scan of the lung of the donor, which was done and didn’t show anything that looked like COVID.”
He added, “We do all those things and say, ‘Well, as best we can determine, this donor is safe to use.’ But unfortunately in this case, there was asymptomatic COVID that was not detected by the standard testing.”
The Washington Post noted that more than 39,000 transplants were performed in the United States in 2020, according to data compiled by the United Network for Organ Sharing. That included approximately 2,500 lung surgeries, with COVID-19 patients among those. In June, a woman in her 20s became the first known person infected with coronavirus to receive a double-lung transplant in the United States.