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A lung-transplant patient has died after mistakenly receiving coronavirus-riddled organs, a case report has revealed.
Writing in the American Journal of Transplantation, doctors from the University of Michigan describe how a deceased donor tested negative for the infection via a nasal-throat swab two days before her lungs were "procured".
Three days after the double-lung transplant was carried out, however, the unnamed female recipient developed a fever, low blood pressure and laboured breathing.
Fluid from deep in the recipient's lungs later tested positive for the coronavirus, which genetic sequencing linked to similar donor samples.
The recipient rapidly deteriorated, developing multi-system organ failure that forced the doctors to put her on life support.
Despite the medics' best efforts, the woman failed to improve, prompting her life support to be withdrawn 61 days after the transplant was carried out.
The lungs were transplanted from an unnamed woman who died following a severe brain injury in a car collision, Kaiser Health News reported.
The deceased tested negative for the coronavirus via a nasal-throat swab within 48 hours of her lungs being procured, with her also having "no clinical history or findings suggestive of infection".
"We would absolutely not have used the lungs if we'd had a positive COVID [the disease caused by the coronavirus] test," said Dr Daniel Kaul, who co-authored the case report.
Lower respiratory tract testing was not carried out, however.
The recipient had chronic obstructive lung disease; defined as damage to the air sacs or long-term respiratory inflammation.
She too tested negative for the coronavirus prior to the transplant.
Three days after the procedure, however, the recipient developed relatively mild symptoms. She went on to endure a waning heart function and septic shock; a dangerous drop in blood pressure.
A nasal-throat swab continued to come back negative, however, the recipient's "bronchoalveolar lavage [BAL] fluid" tested positive. BAL describes fluid deep in the lungs.
Watch: Can you catch coronavirus twice?
A surgeon present during the transplant also later tested positive for the coronavirus.
The Michigan doctors sequenced the recipient's BAL fluid, as well as a sample provided by the surgeon and fluid they had kept from deep in the deceased's lungs, all of which "proved donor origin" for the infection.
With the recipient developing multi-system organ failure, she was treated with the Ebola drug remdesivir, which has thrown up mixed results when tested among coronavirus patients.
The woman was also given blood plasma from people who have overcome the coronavirus, in the hope she may benefit from their infection-fighting antibodies.
As a last-resort, doctors put the woman on extracorporeal membrane oxygenation; a machine that removes carbon dioxide from a patient's blood, while enriching it with oxygen.
Despite the medics' best efforts, the life support was eventually withdrawn.
Donor-derived disease 'rare'
The Michigan doctors called the incident "a case of proven transmission of [coronavirus] from lung donor to recipient"
The US Centers for Disease Control and Prevention (CDC) has previously reported eight cases of organ transplant recipients later testing positive for the coronavirus.
The CDC team concluded, however, "the most likely source of transmission was community or healthcare exposure, not the organ donor".
The coronavirus is considered a respiratory infection, however, it can affect many parts of the body, causing some patients to endure fatigue, diarrhoea and rashes.
Organ damage has even been reported in severe cases.
Dr Kaul said, however: "It seems for non-lung donors it may be very difficult to transmit COVID, even if the donor has COVID."
The coronavirus aside, a 2016 study flagged the risk of "donor-derived disease", with some patients developing kidney cancer or life-threatening fungal infections.
This is "rare", however, with the study revealing just 0.33% of deceased donors transmit disease, while 0.04% of recipients die as a result.
Nevertheless, the Michigan doctors want transplant centres and "organ procurement organisations" to test the lower respiratory tracts of potential donors for the coronavirus.
"Consider enhanced personal protective equipment for healthcare workers involved in lung procurement and transplantation," they added.
As the pandemic continues to unfold, the Michigan doctors want to reassure people that they should continue to have organ transplants if needed.
"The risks of turning down transplants are catastrophic," said Dr Kaul.
Watch: What is long COVID?