Background: Coronavirus disease 2019 (COVID-19) is associated with diffuse alveolar damage (DAD) and coagulopathy in severe ill patients. Objective: To better understand and disease management, we investigated postmortem needle biopsies of lung, liver, and kidney pathologic changes along with clinical course, hematologic and imaging findings in two COVID-19 decedents. Patients and method We examined pathology of two patients with confirmed positive SARS-CoV-2 test died from respiratory failure. Computed tomography (CT) of the chest, Clinical and laboratory findings were investigated. Postmortem needle biopsies of lung, liver, and kidney were performed with complete protection. Results: The patients died from acute respiratory distress syndrome (ARDS). One of the patients was 56-year old man without any predisposing factor and the other (83-year old man) had hypertension, diabetes mellitus and renal failure. The patients had lymphopenia, elevated C-Reactive Protein (CRP), ferritin and D-Dimer. Axial CT images show diffuse ground glass opacity with some crazy paving and consolidation. The main pathologic finding of lungs revealed DAD. Intravascular micro-thrombi were detected despite anticoagulant prophylaxis. Renal autopsy demonstrated acute tubulointerstitial nephritis (ATIN) with tubular epithelium attenuation. Liver biopsy was consisted of lobular and portal inflammation and steatosis Conclusion This study emphasis that diffuse alveolar damage and microvascular pulmonary thrombosis in SARS-CoV-2 patients caused by either direct viral cytopathic effect or host immune and inflammatory reaction. Due to severe hypoxemia in COVID-19 patients suffering ARDS, appropriate oxygen support and anticoagulation therapy with strict monitoring is recommended