A Woman’s Tragic Covid-19 Death Traced to Tainted Donated Lungs, Report Finds

Illustration for article titled A Woman's Tragic Covid-19 Death Traced to Tainted Donated Lungs, Report Finds

Photo: Christopher Furlong/ (Getty Images)

Doctors say that a Michigan woman’s untimely death last fall was caused by covid-19 unknowingly spread through a double lung transplant. It’s likely the first clear case of covid-19 linked to transplantation. Another doctor contracted the viral illness through the procedure, but survived.

The woman’s tragic case was detailed in a report published earlier this month by doctors at the University of Michigan Medical School, in the American Journal of Transplantation. According to the report, the woman needed the transplant because of her chronic obstructive pulmonary disease. Her donor was a woman who had recently died of severe brain injury from a car accident. Standard screening, including a nasal and throat swab test for the coronavirus (SARS-CoV-2) on the donor and recipient, turned up nothing unusual and the procedure appeared to go off without a hitch.

Three days following the transplant, however, the recipient spiked a fever and began to have trouble breathing. A nasal swab test initially showed no traces of the coronavirus, but she obviously had pneumonia and a later direct test of her lungs came back positive for the virus. Over the next two months, the woman’s condition only worsened, and she developed septic shock. Though she was treated with antivirals, convalescent plasma, and ECMO (a last resort medical device that takes over for the heart and lungs), the woman succumbed to her illness 61 days after her transplant.

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The donor had no history indicating recent exposure to the coronavirus or symptoms of covid-19 prior to her death, along with a negative nasal swab test. But doctors had held onto a fluid sample collected from her lungs and when they tested it after the recipient became sick, it came back positive. Genetic sequencing of the virus found in both the donor and recipient showed they were nearly identical, effectively proving the recipient’s infection came from the tainted lungs. A third person—one of the woman’s surgeons who handled the lungs—became sick and tested positive for the virus soon after the procedure, and this infection was also traced back to the donated lungs. The surgeon recovered, however, and no other member of the transplant team was affected.

There have been other suspected cases of covid-19 spread through transplantation, but this is thought to be the first known case to demonstrate transmission by using genetic sequencing. Despite the tragedy of this death, however, it’s likely still an incredibly rare risk. This same month, scientists with the Centers for Disease Control and Prevention looked into eight suspected cases of covid-19 linked to organ donation documented between March to May 2020. They ultimately concluded that the most likely source of transmission in these cases “was community or healthcare exposure, not the organ donor.”

Rare as it might be, the Michigan doctors do think more can be done to ensure the safety of organ recipients and their doctors during this time, particularly when lungs are being transplanted.

“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 health care workers involved in lung procurement and transplantation,” they wrote.

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Doctors Studied People’s Last Moments of Life to Figure Out When Death Begins

Illustration for article titled Doctors Studied Peoples Last Moments of Life to Figure Out When Death Begins

Photo: Alex Wong (Getty Images)

New research suggests that doctors are, thankfully, skilled at correctly identifying a person’s time of death—a crucial aspect of ensuring healthy organs for donation. At the same time, the body can sometimes show flitters of cardiac activity even after death has become truly irreversible, according to the study published in the New England of Medicine.

There’s no shortage of morbid curiosity surrounding death. But according to the researchers behind this project, known as the Death Prediction and Physiology after Removal of Therapy Study, or DePPaRT, there’s a lot we don’t know for sure about a person’s last minutes of life.

Since 2014, they’ve been collecting vital sign data from dying patients in Canada, the UK, and the Czech Republic as part of their work. Their main goal has been to document as much as possible about the process of dying, particularly in critically ill people who are taken off life support. They’ve also been studying how and why families decide to donate the organs of their loved ones soon before death and how the donation affects them. People in the study—around 600 in total— were only included after express consent from their families. The project received funding from the Canadian government as well as the Canadian Donation and Transplantation Research Program.

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Though some organs, like the kidneys, can be kept viable for over a day before being transplanted, others, like the heart, have to be transplanted within hours. Any delay can be literally the difference between life and death for the organ recipients. But people are understandably sensitive about death, and many families and some doctors may hold out hope of a miraculous recovery even after a person is taken off life support.

“We recognize that there are stories about people coming back to life, even from members of the medical community. So we really wanted to provide scientific evidence about the process of dying, to dispel any potential myths for people,” lead researcher of the project Sonny Dhanani, a pediatrician at the CHEO Research Institute in Ontario, told Gizmodo by phone.

Nowadays, doctors in Canada are told to wait at least five minutes after blood circulation has stopped after the end of life support before officially calling a person’s time of death (in the U.S, two to five minutes is recommended). In the patients this team studied, there were no cases where doctors were wrong about their determination of death. That said, the movie-friendly sign of death—an immediate flatline on a EKG monitor—wasn’t completely right, either.

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Sometimes, in about 14% of patients, there were on-and-off moments of cardiac activity. Importantly, though, these moments usually lasted for a few seconds and didn’t result in the heart fully restarting or in people suddenly waking back up. The longest time it took for a heart to fully stop was around four minutes, indicating that the five-minute rule is indeed a good amount of time to wait for the determination of death (should the heart restart during that period, doctors will then wait another five minutes before declaring the time of death).

“Doctors and families should be aware about this happening 14% of the time. But they also should be reassured that it doesn’t mean that the person will come back to life,” Dhanani said.

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That reassurance is all too important for families, especially when it comes to decisions around organ donation. Of course, people can also offer that permission themselves by preemptively registering as an organ donor.

Dhanani and his team were surprised by how many families chose to participate in the project when asked (93%). And he hopes his team’s work will help people better recognize the benefits of organ donation, while putting their minds at ease about the process.

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“Ultimately, we want our research to help open up the conservation around death, dying, and donation, which are topics that can be uncomfortable,” he said. “And we hope that this research can reassure people worried about the idea of being a donor, maybe because they fear their organs will be taken before they die. There’s a clear process to donation, and our research has shown people won’t be mistreated.”