Transplant recipient unknowingly gets coronavirus-infected lungs, dies 2 months later

INDIANAPOLIS (WISH) — A transplant recipient contracted COVID-19 after getting virus-infected lungs from her donor. The unnamed woman from the Midwest died two months after the surgery. However, both the donor and recipient tested negative for the coronavirus prior to the transplant.

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Researchers investigated the case and concluded the test results from the donor’s end must have been a false negative. The woman contracted the coronavirus as a direct result of her new, yet infected, lungs. Researchers published their findings in the American Journal of Transplantation.

This was an isolated incident and one doctor is easing fears about lung transplantation amid the pandemic. 

News 8 spoke with Dr. David Nunley, medical director of the lung transplant program at Ohio State Wexner Medical Center, to talk about the successful work he and his team have been doing since the rapid rise in lung transplants during this time. 

Gillis: We are talking about lung transplants during the pandemic. I understand you’ve had a lot of success in this area. Can you talk about the center and what you’ve been doing?

Nunley: The Ohio State Wexner Medical Center is a very prolific transplant center. Speaking of lungs, we’re one of the top ten programs in the country in terms of volume of transplants performed with exceptional survival rates for our recipients.

The recent COVID-19 pandemic has certainly added a new slant to our work. Many patients cannot recover from the lung injury from COVID-19 by themselves and are in need of a transplant. Since the fall, we’ve had over 20 referrals for patients who are either on a mechanical ventilator or requiring continual oxygen and cannot be liberated from that level of support. 

Unfortunately, not every patient can qualify for a transplant, but we certainly evaluate everyone very carefully and we’ve been able to perform five transplants for COVID-19 related injuries while we have another three of four patients currently being considered for transplantation. 

Gillis: Is there a specific marker that makes someone qualified for transplantation?

Nunley: Every person has to be considered individually of course. But in this pandemic and the severe lung injury that can occur one of the challenges we have is knowing when that lung disease is so advanced that it’s unlikely to be reversible. 

Typically if we see significant scarring in the lung tissue that usually has been the trigger for us to consider transplantation at that time. There may be reasons someone may not qualify. We know that people who have other medical problems especially advanced kidney disease or advanced heart disease may not benefit from transplantation. So, again all of those cases have to be looked at individually.

Gillis: I want to talk about some of the complexities that you might be facing at this time. Are people hesitant to come in because they are fearful of contracting the virus? We’ve been seeing that happen this past year–people avoiding medical appointments for fear of getting COVID-19.

Nunely: Like most hospitals back in the spring back of 2020 I think a lot of lung transplant centers–including here–scaled down because of concerns not only about the risk to health care workers in the hospital, but also patients and other people coming into the hospital who may not need urgent hospitalization. 

I think when the COVID-19 cases kind of died off in the summer those enterprises re-engaged and went back into high gear. After the second surge, we decided there were so many people out there that could potentially benefit from our services so we did not scale down during the second surge. And I think that has allowed us to consider these patients who may be in need of transplantation. So, certainly that added a level of complexity and was a learning curve for all of us. But we knew we wanted to continue this during this time. 

Gillis: On to another topic. About six weeks ago there was a study that came out. A woman needed a lung transplant and she became infected with the coronavirus because her donor had COVID-19. Do you have any sense of why that happened?

Nunley: When testing became more widely available late last spring and early summer certainly all donors were tested at their donor hospitals at least on two occasions to ensure they were not infected. We know there are several tests for the coronavirus. Some that are rapid. Some that take longer but are more specific for identifying the disease. 

So, all donors now are screened. In the case in Michigan–I’m not privy to all of that information–but with tests there is always a margin of error. I suspect that the donor was tested and probably had a false negative result. Again, I don’t have the inside information. But that’s a very very uncommon and rare occurrence. 

Gillis: And in terms of testing…there is still sort of this lag. Latest statistics I’ve read is that a person is 40% likely to have a false negative result within two days of infection and 20% within four. What do you think about that? I mean because you have to get that lung in there as soon as possible. 

Nunley: Right. Once an organ is procured from a donor the clock is ticking. You want to try and do that surgery between donor and recipient ideally within four to six hours. And, of course, that leaves you very little time to confirmatory testing. Right now, what we have is state-of-the-art of doing the testing. 

Now, some donors may be at the hospital for a couple of days before the procurement is done and therefore you may have a little bit more opportunity in those individuals. 

Gillis: We’re almost out of time. Last thirty seconds. What would you like to say?

Nunley: Obviously, we’d like everyone to be vaccinated. And we’re glad that we can provide this service for those who are in need. The message I would give providers is that if you have someone in the ICU and they are not progressing at least raise the issue of transplant as an option and discuss the possibility. 

I’d also like to say this is an effort of a great team. It’s not just a surgeon or a pulmonologist. It takes nurse coordinators, social workers among many others to pull this off and make it work. And then, of course, we couldn’t do any of this work unless patients, people and families didn’t choose to give the donation.