In a finding that could mean more patients desperate for a heart transplant get a new lease on life, two new studies show that hearts from donors who abused drugs can be safely donated.
In the past two decades, the U.S. opioid crisis has taken the lives of hundreds of thousands of Americans -- often young, otherwise healthy people. One result is that a rising percentage of potential donor organs come from people who abused drugs.
For a long time, the question was whether those organs were more likely to fail in the long run.
Research in recent years has been offering reassurance on those issues. And experts said the two new studies provide even more.
In one, researchers looked at long-term survival among U.S. heart transplant patients who'd received an organ from a donor who'd died of a drug overdose, or who had a history of using illegal drugs.
They found no evidence of a dimmed outlook: Roughly 60% of transplant recipients were still alive 10 years later, whether the donor had been a drug user or not.
Dr. David Baran, the lead researcher on that study, said he hoped the findings would help "move the needle" toward broader use of such donor hearts.
The United States has seen an increase in heart transplants in the past few years -- and that's partly because of the spike in opioid overdose deaths and the resulting donor organs.
At the same time, many drugs -- from cocaine and methamphetamines to Ecstasy and alcohol -- can damage the heart. So, there have been lingering concerns about how well hearts from "intoxicated donors" will function in the long run, explained Baran, of Sentara Heart Hospital in Norfolk, Va.
"People in the transplant field tend to be risk-averse," he said. "They want to do the best thing for their patients."
But while on the surface, it might seem like organs from a drug user would be lower in quality, that's not grounded in evidence, Baran noted.
As long as screening shows the heart function is good, he said, there is no reason to discard a potentially lifesaving organ.
Dr. Howard Eisen, chair of the American Heart Association's (AHA) Heart Failure and Transplantation Committee, echoed that sentiment.
"This research confirms previous data that these hearts -- once considered high risk -- are safe," he said in an AHA news release. "These findings should encourage institutions who are not routinely using hearts from drug users to do so."
The findings, published July 28 in the AHA journal Circulation: Heart Failure, are based on nearly 24,000 U.S. adults who had a heart transplant between 2007 and 2017.
Using information from hospital urine tests taken before donors died, the researchers identified illicit drugs the donors had used -- such as opioids, cocaine, methamphetamine and alcohol.
Overall, around 90% of transplant recipients were alive one year later, regardless of whether the donor had used any drugs. Five-year and 10-year survival rates were also similar, regardless of the donor's drug history.
The second study, published July 28 in the Journal of the American Heart Association, found that survival rates among heart transplant recipients have been rising in the past 15 years.
On average, Americans who received donor hearts between 2013 and 2017 were 21% less likely to die within a year, compared to their counterparts a decade earlier. That's despite the growth in donors who died of overdoses.
In a related trend, the United States has seen an increase in organ donors with the liver disease hepatitis C -- which is often spread through IV drug use.
Historically, those organs were usually discarded. But that has changed in the past several years, with the advent of new medications that eradicate the hepatitis C virus.
If the medications are started right after a heart transplant, patients only need to take them for a month, said senior study author Dr. Ravi Dhingra.
Since 2015, his team found, there's been an uptick in use of hearts from hepatitis C-positive donors.
"But we still have a lot of work to do," said Dhingra, medical director of the heart failure and transplant program at the University of Wisconsin-Madison.
Dhingra thinks that data from studies like these two will encourage more transplant programs to use donor hearts from people who died of opioid overdoses or who had hepatitis C.
"These hearts are good, and the overall survival is the same," he said.
It's estimated that 20% of Americans on the wait list for a heart transplant either die or are removed from the list due to deteriorating health. A key way to address that, Dhingra said, is to make better use of the donor hearts that are already available.
The United Network for Organ Sharing has more on heart transplantation.
SOURCES: David Baran, MD, system director, advanced heart failure and transplantation, Sentara Heart Hospital, Norfolk, Va.; Ravi Dhingra, MD, MPH, medical director, heart failure and transplant program, and associate professor, medicine, University of Wisconsin-Madison; Circulation: Heart Failure, July 28, 2021, online; Journal of the American Heart Association, July 28, 2021, online