(NEXSTAR) – A Michigan woman contracted COVID-19 and died two months after receiving a double lung transplant from a person who was later found to have had coronavirus, doctors say.

The case is believed to be the first documented instance of SARS-CoV-2 being transmitted through donated organs, according to a report in the American Journal of Transplantation.

“We would absolutely not have used the lungs if we’d had a positive COVID test,” lead author Dr. Daniel Kaul, director of the Transplant Infectious Disease Service at the University of Michigan Medical School, told Kaiser Health News.

The donor was a woman from the upper Midwest who was hospitalized and ultimately pronounced brain dead after a car crash. According to the study, she was given a nasal swab test within 48 hours of the transplant and it turned up negative.

The recipient had chronic obstructive lung disease and also tested negative before the transplant surgery last fall.

By the third day after the transplant, the woman developed a worsening fever, low blood pressure and had difficulty breathing. When she developed sceptic shock, doctors called for another coronavirus test and she turned out to be positive.

Doctors then retested the donor at a University of Michigan lab – this time using fluid taken from deep in the lungs – and the woman tested positive as well.

The transplant recipient died 61 days after receiving the new lungs.

Four days after the operation, a surgeon who performed the transplant also tested positive for COVID-19, but later recovered. Because both patients initially tested negative for coronavirus, the surgeon wasn’t required to wear an N95 mask or eye protection during the operation.

Doctors say the unexpected transmission of an infection from donor to recipient is quite rare and happens in less than 1% of patients.

The study called for the use of not just nasal swabs, but also the deep lung fluid test, called a bronchoalveolar lavage, or BAL, as well as enhanced protective equipment for hospital staff involved in the transplant.