A lifesaving operation turned tragic when a Michigan woman contracted COVID-19 from her double lung transplant last year and died soon after.

The case marks the first time that doctors have confirmed COVID-19 transmission through an organ transplant, according to a report of the case, published Feb. 10 in the American Journal of Transplantation.

A surgeon involved in the woman’s case also contracted COVID-19, likely during the transplant procedure, the report said. The surgeon later recovered, according to Kaiser Health News.

Given that this is the only confirmed case of COVID-19 spread through organ transplantation out of nearly 40,000 organ transplants performed in 2020, transmission through this route is rare, Kaiser Health News reported. But doctors involved with the case are calling for more extensive COVID-19 testing of lung donors to prevent such transmission from happening.

In this case, the donor, who died in a car accident, was unknowingly infected with COVID-19 and tested negative on standard tests of the nose and throat. “We would absolutely not have used the lungs if we’d had a positive COVID test,” Dr. Daniel Kaul, director of Michigan Medicine’s transplant infectious disease service and lead author of the report, told Kaiser Health News.

The lung transplant recipient was a woman with chronic obstructive lung disease (COPD). Her transplant procedure went smoothly, but just three days after the operation, she developed a fever and breathing problems and was placed on a ventilator. Samples from her lungs tested positive for COVID-19.

Though standard COVID-19 tests came back negative, doctors found a sample of fluid that had been washed through the donor’s lungs. This lung fluid sample tested positive for COVID-19.

Genetic sequencing revealed that the coronavirus infecting the recipient and the donor were identical, confirming that the recipient contracted the virus from the donor lungs. The surgeon, who got sick four days after the transplant procedure, was also infected with a virtually identical virus, which he likely contracted from material expelled from the donor lungs during the operation, the report said.

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After contracting COVID-19, the transplant recipient developed multiorgan failure and died two months later, despite extensive treatment, Kaiser Health News reported.

“Transplant centers and organ procurement organizations should perform SARS-CoV-2 testing of lower respiratory tract specimens [from deep in the lungs] from potential lung donors,” the authors wrote in their paper. In addition, transplant centers should “consider enhanced personal protective equipment for health care workers involved in lung procurement and transplantation,” such as N95 masks and eye protection, they concluded.

Originally published on Live Science.

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