At the University Hospital in Ann Arbor, Michigan, a woman received a double lung transplant — and died 61 days later. Doctors have now confirmed that the donor’s lungs were infected with Covid-19, which spread to both the transplant recipient and also the surgeon.
The Doomed Operation
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The Michigan woman underwent this failed lung transplantation in the fall. What should have been a life-saving thoracic surgery was always going to be high-risk during a pandemic, but precautions were taken. The organ donor, who had perished in a car accident was checked for Covid-19 via PCR swab and tested negative. The surgeon, Dr. Lin, wore a mask throughout the procedure — even though that is not standard practice during the intense, hours-long surgery. (He recommends that all transplant centers do the same.)
But it was not enough. Four days later, Dr. Lin tested positive for the Coronavirus. Then the doctors began to worry. University Hospital had retained a specimen from the donor’s lower respiratory tract and discovered SARS-CoV-2. The transplant recipient, who quickly began to suffer from respiratory distress and skeptic shock, never recovered. Though she underwent extended hospitalization which included treatments of convalescent plasma, steroids, remdesivir, she — and her new lungs — could not beat severe Covid-19. Her death was announced this week.
What Went Wrong?
A case report American Journal of Transplantation details the event, emphasizing its rarity. Normally, the rate of unexpected infection transmission during a transplant is less than 1%. Lead author Dr. Daniel Kaul, who oversees the Transplant Infectious Disease Service at the University of Michigan Medical School, said “It’s important to emphasize that this is, fortunately, a rare event.” 40,000 organ transplants have taken place over the past year in the U.S. and the instance in Michigan remains the only confirmed case of the recipient contracting coronavirus.
However, it raises questions regarding how we can more accurately test donated organs. Tests for the Coronavirus are not normally conducted by transplant surgeons. Usually, an organ procurement organization handles the process. The Association of Organ Procurement Organizations declined to answer The New York Times inquiry about this case. But chief clinical officer Bruce Neily of Gift of Life Michigan admitted that early on in the pandemic, many labs were scared to run samples from the lower lungs thinking that doing so could spread the virus.
But in the wake of this lung transplant patient’s tragic — and likely avoidable — death, doctors hope that coronavirus testing standards are heightened for organ donors, even if that process is difficult. Samples from the donor’s lower respiratory tract could have been taken before the situation became end-stage.As seen in the video above, double lung transplants can be used to save Covid-19 patients — not to spread the disease.