A woman who underwent a double lung transplant at the University Hospital, Ann Arbor, Michigan died 61 days after the transplant due to COVID-19 that was transmitted through the donated lungs. This is the only confirmed case among nearly 40,000 transplants in 2020 in the US and was reported in the American Journal of Transplantation. The donor had died after sustaining a severe brain injury in a car accident; she had shown no prior symptoms of COVID-19, and there was no recent history of travel or exposure to someone with COVID-19. The nose and throat samplescollected from both the donor and recipient had tested negative for SARS-CoV-2.

Three days after the lung transplant, however, the recipient developed a fever and hervital signs were compromised. Imaging showed signs of lung infection. As her conditionworsened, samples from her new lungs were tested for SARS-CoV-2 and they came back positive. Based on the possibility that the infection could have come from the donor, doctors tested a sample of fluid that they had kept, washed from deep within the donor lungs. It was positive for SARS-CoV-2. Four days after the transplant, the surgeon who handled the donor lungs and performed the surgery tested positive, too. Genetic screening revealed that the recipient and the surgeon had been infected by the donor. The recipient deteriorated rapidly, developed multi system organ failure and died.

This incident has shown that SARS-CoV-2 can be transmitted through infected lungs andit signals the need for testing samples from the donor's lower respiratory tract, as well asfrom the nose and throat. On the other hand, obtaining and testing such samples from donors can be difficult to carry out in a timely fashion and there is also the risk of introducing infection into the donated lungs.