Dr. Daniel Kaul, director of the transplant infectious disease service at Michigan Medicine, which is the University of Michigan’s medical arm, told Crain’s the donor and recipient were tested for coronavirus before the operation last fall with negative results. The transplant procedure had no complications, Kaul wrote in the article.
But three days after the lung transplant, the female recipient became sick with a fever, hypotension and pulmonary infiltrates, or mucus-like substances on the lungs. Imaging suggested a lung infection.
The recipient, who was not identified, needed the transplant for a severe case of chronic obstructive lung disease. She died 61 days after the transplant. Kaul declined to provide the dates of the operation and her death.
The organ donor was a woman from the upper Midwest who suffered severe brain injury in an automobile accident and progressed to brain death during a two-day hospital stay.
The deceased donor tested negative for COVID-19 with a nasal swab within 48 hours of procurement of the lungs and the recipient tested negative 12 hours before the transplant. After the recipient fell ill, follow-up testing revealed both women had COVID-19.
As a result of the transplant patient’s death, Kaul said doctors recommend changes in how transplant teams test donors in lung transplant cases.
“My personal view is that all donors should have a specimen tested from deep in the lungs as well (as a standard nasal swab test), even if there isn’t any reason to think about COVID, at least while COVID remains relatively widespread,” Kaul said.
One issue is that transplant centers don’t always have control over asking for special tests, Kaul said. Still, he said, a fluid test should be taken from the lower respiratory tract to be sure.
“We are requesting that (for lung donations),” he said “In Michigan, the Gift of Life is doing that as routine if someone is going to be a donor.”
Since last fall, when the lung organ transplant recipient was diagnosed with COVID-19, several lower respiratory tract tests have been performed on other lungs to be used for transplants with no problems found, Kaul said.
After the lung transplant recipient’s positive test, Kaul said the thoracic surgeon and the 10-member transplant team received polymerase chain reaction (PCR) tests for COVID-19.
The thoracic surgeon who prepared the donor lungs for implantation and performed the procedure tested positive. The other transplant team members continued to test negative.
Genetic sequencing confirmed the donor lungs as the source of the recipient’s and surgeon’s COVID-19 infections, Kaul said.
“It was very sad and tragic this happened,” he said. “This is the only proven case of a donor-to-recipient transmission of COVID, which is good news. This shows, in general, the kind of screening that’s going on is working. It also probably suggests that, especially if the donor has a mild case, that it may be hard to transmit it from non-lung organs.”
Still, Kaul said Michigan Medicine is recommending more precautions be taken to test for fluids deep in donors’ lungs.
In addition, to further protect transplant teams, the AJT article suggests that transplant centers also should “consider enhanced personal protective equipment for health care workers involved in lung procurement and transplantation.”
At least several times since last fall, Kaul said transplant recipients have been called in for a transplant and found out that the donor had tested positive for COVID-19.
“They didn’t have symptoms, because we wouldn’t have called them in if they did, but once we tested the transplant had to be canceled,” he said.
Last March, when the COVID-19 pandemic was beginning, the 12 transplant centers in Michigan, including University Hospitals, Henry Ford Hospital and Barbara Ann Karmanos Hospital, were forced to postpone transplant operations, Crain’s reported.
The reasons were varied, but mostly they were to protect patients who are at a higher risk of infection from contracting the virus.
Other reasons include fewer live organ donations, shortages of blood, plasma, staff, supplies and equipment, including mechanical ventilators that were being used for severely ill COVID-19 patients.
By the end of 2020, Kaul said transplant operations at Michigan Medicine were back to pre-pandemic numbers. However, for reasons unrelated to COVID-19, lung transplants are in higher demand.