Can COVID-19 spread through organ transplants?

In the weeks that followed, the transplant patient received the best COVID-19 treatments available, including remdesivir and convalescent plasma, but doctors were unable to save her. Two months after the procedure, she was dead. A re-examination of respiratory fluid taken from her donor before surgery revealed the source of the infection: The transplanted lungs doctors sewed inside her body were teeming with coronavirus.

I’m a doctor specializing in diagnostics, so one quirk of my pandemic experience has been getting a lot of text messages from my friends about the polymerase chain reaction. PCR is used in laboratories to identify everything from genetic conditions to infections to cancers, although you probably know it as the ‘gold standard’ method for detecting SARS-CoV-2, the virus that causes COVID. -19. Friends who texted me had been tested for COVID-19 and wanted help interpreting their results.

A COVID-19 test result seems straightforward at first glance: you are either positive or negative. But questions often follow: What if you feel a little sick, but your test is left blank – can you risk going back to work? Or what if your test is positive, but you feel perfectly fine – should you repeat it later to confirm you’ve recovered? How long after? In the early months of the pandemic, I got tangled up giving advice to friends based on what was already known about the technology and preliminary data from China. Probably not, I said. Perhaps. A week or two? I couldn’t say much for sure.

A year later, my colleagues and I have more and more facts to help us navigate this diagnostic slope. Now we know that a positive PCR result won’t tell you if you are currently contagious, but it can tell – with 99.9 percent clarification – that you have been infected with SARS-CoV-2. As for false negatives, broader analyzes suggest that about one in eight infections could be missed.

There is a specific branch of medicine where even these modest risks of error simply cannot be met. For the most 107,000 Americans who are now waiting for an organ transplant – and for those who have already received an organ – the stakes of the COVID-19 test are repeatedly magnified. It’s easy to see how a missed donor infection could lead to life-threatening complications for the transplant recipient, such as in the tragedy of last fall. But a false positive result – a case of COVID-19 that is not real or has been recovered for a long time – can also be fatal, when it delays or prevents an organ from reaching a desperate patient. It’s hard enough for primary care physicians to interpret a surprising test result. For those working in transplant medicine, decisions made in this uncertainty could be irreversible.

“It’s my worst nightmare,” Joshua Lieberman, a University of Washington pathologist who works on transplant testing, said when I asked about the Michigan case. He was particularly struck by the extent of the infection found in the donated lungs. “There isn’t a bit of COVID in there. It’s extremely positive, ”he said of the PCR results -“ like, a million times more viruses ”than he usually sees.

About Hector Hedgepeth

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