Feb. 23—Surgeons at Michigan Medicine have confirmed what is believed to be the first proven case of COVID-19 spread from an organ donor to an organ recipient through transplantation.
A woman in Michigan came down with symptoms a few days after receiving a double lung transplant and died two months later, according to the University of Michigan health system. A surgeon who handled the donated lungs was also infected but recovered.
The discovery, which was made in October, comes as transplant surgeries are returning to normal levels following a sharp downturn early in the pandemic. It also is leading to calls to change the way lung donations are tested to better detect COVID-19.
Transmission through organ transplantation has been suspected in other cases, but this is believed to be the first case where the connection has been proven, said Dr. Jules Lin, the UM thoracic surgeon who was infected as part of the transplant team and co-author of a paper on what happened.
"It can happen with other transplants, but COVID especially affects the lungs," Lin said.
He was infected with the virus while handling the organs during surgery. "I was off work at home for 10 days but didn't need to be hospitalized."
Transmission of the virus occurred even though the donor had no symptoms of COVID-19 and had tested negative for the SARS-CoV-2 virus within 48 hours of the organ's procurement.
The lungs were donated by a woman from the Midwest who died in a car crash. She initially tested negative on a reverse transcriptase polymerase chain reaction (RT‐PCR) taken on a nasopharyngeal swab obtained within 48 hours of the organ's procurement. The lower respiratory tract wasn't tested.
Three days after the transplant, the recipient developed a fever, hypotension and lung symptoms.
The recipient again tested negative on an RT-PCR test on a nasopharyngeal swab. But fluids from the lower respiratory tract, collected during a bronchoalveolar lavage procedure, tested positive for the SARS-CoV-2 virus.
Experts at Michigan Medicine — the University of Michigan's health system — sequenced whole genomes of virus samples taken from the donor, the recipient and the doctor who became ill, and found all three samples were genetically identical. Other tests confirmed the virus originated with the donor, Lin said.
Though donor-to-recipient transmission is exceedingly rare, the discovery is likely to spur changes in testing of organ donors throughout the country.
"We're bringing this up to make other centers aware that this can happen and (can consider) if additional testing can be done or should be done," Lin said. "That's what's being looked at at both the national level, the local level and with organ procurement organizations."
The case report has been peer-reviewed and accepted for publication by the American Journal of Transplantation. The paper is still undergoing editing but was published online on Feb. 10.
The discovery comes as the number of transplant surgeries is returning to normal levels following a dramatic decrease early in the pandemic, said Bruce Nicely, chief clinical officer with Gift of Life Michigan, which assists transplant teams with procurement, preservation and transport of organs.
"The biggest dip was back in April 2020 ... and particularly in Michigan, because we were hit hard early on," Nicely said. "Not knowing fully how this virus transmitted, what effect it had on various organs, etc., a lot of programs became extremely conservative in transplanting patients."
News of the case has brought calls for additional testing of donors, especially those donating lungs.
Gift of Life is working with transplant doctors at Michigan Medicine to finalize a new testing protocol for the testing of lung donors that will include bronchoalveolar lavage testing, Nicely said.
"It is likely to give (transplant) programs pause, and certainly the opportunity to revisit whether the steps they're taking are the right ones, and enough," Nicely said.