A double-lung transplantation was carried out successfully from a donor who had previously been infected with the coronavirus, according to a case report from Belgium.

The transplantation was completed without viral transmission to the recipient, and recovery after 90 days was excellent, according to researchers.

Though only a single case, the success of the transplantation may offer some reassurance given that a relatively large proportion of future organ donors are likely to have contracted Covid-19 at some point during the pandemic.

“Since SARS-CoV-2 resides primarily in the respiratory tract, lung transplantation has the highest concern in terms of donor-derived viral transmission and impaired graft quality,” wrote authors led by Dr Laurens Ceulemans, of University Hospitals Leuven, in The Lancet: Respiratory Medicine.

The donor was a 72-year-old woman who developed COVID-19-like symptoms in April. Her symptoms, which included fever, cough, weakness, and muscle pain, lasted for two weeks; she was not tested for COVID-19 at the time due to low testing capacity in Belgium.

During the period of her symptoms, however, her husband was admitted to the hospital and died from confirmed COVID-19. Three months later the woman was admitted to the hospital with intracranial bleeding, and serology testing showed positive SARS-CoV-2 antibodies.

PCR testing was negative at the time of donation. The recipient was extubated after two days, and was discharged from the hospital 35 days after surgery. SARS-CoV-2 tests performed 15, 34, and 90 days after transplantation were all negative. At day 90, spirometry was normal, and a peripheral lung biopsy sample was negative for SARS-CoV-2.

“If recommendations are followed, the risk of donor-derived transmission for SARS-CoV-2 is very low,” the authors wrote. “Therefore, in coming years, the systematic use of rapid and highly sensitive SARS-CoV-2 detection methods will be indispensable for every donation.”

In August, the International Society of Heart and Lung Transplantation issued guidance regarding various aspects of the Covid-19 pandemic. The guidance noted that a donor with previous COVID-19 and complete clinical recovery, at least 28 days from symptom onset, and two negative PCR tests 24-48 hours apart “may carefully be assessed and ultimately be considered eligible for donation.”

The time since symptom onset could be shortened to 14-28 days if a recipient candidate has a high risk of mortality without lung transplant.

The authors of the new case report added that longer term results with the recipient are still awaited. “We encourage other transplantation centres to report their experience of donors with previous SARS-CoV-2 infection to better inform the transplant community and general population.”