A woman with chronic obstructive lung disease contracted COVID-19 from a pair of donor lungs and died 61 days after the transplant — the first confirmed donor-to-recipient transmission of COVID-19 in the U.S., according to a case report published Feb. 10 in the American Journal of Transplantation.
The transplant was performed at the University of Michigan Medical School in Ann Arbor. The thoracic surgeon who prepared the donor lungs for implantation and who performed the procedure also tested positive for the coronavirus, while 10 other healthcare personnel present during the procedure were negative.
Polymerase chain reaction testing was performed before the procedure. The donor, a woman who died from severe brain injury after a car accident, tested negative 48 hours before procurement, and the recipient tested negative 12 hours before the transplant. Three days post-transplant, the recipient developed a fever and hypotension, while imaging suggested a lung infection.
Physicians sent a bronchoalveolar lavage fluid sample from the recipient, which obtains specimens from deeper in the lower respiratory tract than the nasal swabs used for PCR testing. The sample came back positive, as did a lung fluid sample taken from the donor during procurement. At the same time, a second PCR test was performed on the recipient and did not detect a COVID-19 infection.
Genetic sequencing confirmed the donor lungs as the source of the recipient and surgeon's COVID-19 infection.
"Transplant centers and organ procurement organizations should perform SARS-CoV-2 testing of lower respiratory tract specimens from potential lung donors, and consider enhanced personal protective equipment for healthcare workers involved in lung procurement and transplantation," the physicians said.