Illinois Health Care Worker Receives a “COVID to COVID” Double-Lung Transplant and Returns Home One Year After Contracting COVID-19
Northwestern Memorial Hospital May 14, 2021
On May 14, 2020, Renato Aquino drove himself to the emergency department with shortness of breath due to COVID-19. Exactly one year later, the 65-year-old is sharing his story of survival after receiving one of the first-known “COVID to COVID” double-lung transplants in the United States. On February 25, Northwestern Medicine surgeons successfully performed the transplant using lungs from a donor who previously had COVID-19 and cleared the virus after having mild to moderate symptoms. The donor’s death was unrelated to COVID-19 and their lungs didn’t suffer any permanent damage from the virus, making them viable for transplantation. After receiving the transplant, Aquino is now able to breathe on his own without supplemental oxygen and returned home to Glendale Heights, Ill., where he continues to recover.
“I spent the last year in and out of hospitals, struggling to breathe – not knowing if I’d live or die,” says Aquino, who was born and raised in the Philippines before moving to Illinois 30 years ago for a career in medicine. When the COVID-19 pandemic hit, Aquino was on the front lines as a phlebotomist caring for patients. “I was a healthy guy with no underlying health conditions, but my symptoms started with a fever and quickly got worse. On May 14, I called my niece and said, ‘I can’t breathe – I’m going to the emergency department.’ From that day on, my life completely changed.”
Aquino was placed on a ventilator and given convalescent plasma before being transferred to another hospital for extracorporeal membrane oxygenation (ECMO), a life support machine to help support the heart and lungs. After two months, he was taken off ECMO, but remained on a ventilator as his lungs struggled to recover. On multiple occasions, Aquino’s family was told to say their “final goodbyes” and start making funeral arrangements.
“His doctors told us there was nothing more they could do for him,” explains Aquino’s niece, Tasha Sundstrom. “Then, I saw a news story about lung transplants being performed on COVID-19 patients at Northwestern Medicine and mentioned it to my uncle’s doctors. They called the lung transplant team and I cried tears of joy when Uncle Renato was transferred to Northwestern Memorial Hospital in early February.”
“COVID-19 had caused permanent damage to Renato’s lungs – he was running out of options and running out of time,” says Ankit Bharat, MD, chief of thoracic surgery and surgical director of the Northwestern Medicine Lung Transplant Program, who performed the procedure. “When our team got the call that lungs were available from a donor who previously had the virus, we knew a ‘COVID to COVID’ lung transplant was his best shot at survival. After spending one week on the transplant wait-list, Renato received beautiful, healthy lungs – marking a new milestone for lung transplantation. There’s no evidence of any reactivation of COVID-19 in Renato’s lungs and he’s on track for a full recovery.”
To ensure the donor had cleared the virus from the body, the lung transplant team performed multiple tests that examined the donor’s lung fluid. This same test has been performed before lung transplant procedures at Northwestern Medicine during the pandemic to prevent transmission of COVID-19 to the recipients. The team also performed a lung biopsy in the operating room to make sure there’s no permanent damage to the donor lung. Once the nasal swab and lung fluid both came back clear of the virus and the lung biopsy confirmed there was no permanent damage to the lung, the transplant team felt confident in the quality of the donor lungs. Then, using sophisticated techniques in the Northwestern Medicine research laboratories, it was confirmed the virus was eradicated from the donor lungs and the lung framework and architecture were normal.
“We carefully reviewed the donor’s history to make sure the past COVID-19 infection wasn’t severe, that imaging studies showed no evidence of lung damage and that nasal and airway samples were taken to ensure the donor had cleared the virus,” explains Rafael Garza-Castillon, MD, thoracic surgeon at Northwestern Medicine who assisted with the donor retrieval and transplant. “Once we arrived at the donor hospital, we directly inspected the lungs and took blood oxygen measurements from the pulmonary veins to ensure good lung function. By carefully assessing the donors and when specific criteria are met, we think lungs can be used from those with a history of non-severe forms of COVID-19.”
“Current consensus guidelines are that donors with a history of COVID-19 can be used for organ transplantation as long as they have clinically recovered and have negative testing,” adds Michael Ison, MD, infectious diseases and organ transplantation specialist at Northwestern Medicine. “Currently, many transplant centers are worried about the risk of transmission of COVID-19 from donors, particularly for lung transplants, and are unnecessarily discarding these organs. This transplant demonstrates the safety of using organs from these donors.”
“More than 30 million Americans have contracted COVID-19 and many are registered organ donors. We shouldn’t immediately disregard donors who had mild cases and fully recovered from the virus; especially when there’s already a large supply and demand gap,” says Rade Tomic, MD, pulmonologist and medical director of the Northwestern Medicine Lung Transplant Program. “Approximately 20-30 percent of patients who get COVID-19 can result in some form of lung damage and we are seeing more and more patients require a lung transplant. There will be an increased need for lungs – so we need to be creative and maximize our donor pool. I suspect we’ll start seeing more transplants from donors who had a history of COVID-19.”
The first-known double-lung transplant on a COVID-19 patient in the United States happened at Northwestern Memorial on June 5, 2020. To date, Northwestern Medicine surgeons have completed 20 double-lung transplants on COVID-19 survivors – the most performed at any hospital in the world. All 20 patients are expected to make a full recovery and return to their daily lives.
“I’m not done living yet and have a lot of good to share with the world,” says Aquino. “I love taking care of people and making them happy. I’m ready to get back to being the ‘fun uncle’ who makes silly faces and jokes with my nieces and nephews. I’ve missed out on so much this past year – but thanks to my medical team and organ donor, I have a lot more to gain.”
For information on Northwestern Medicine’s Lung Transplant Program, visit nm.org.