Organs From Opioid OD Victims Are Saving Lives: Study
Organ donations from Americans who have died from an opioid overdose have risen dramatically in the past two decades, new research reveals.
And investigators say that such transplants are just as successful and safe as those involving organs obtained from trauma victims or individuals who die of natural causes.
"This is a relatively recent phenomenon which has occurred as a result of the tragic opioid epidemic currently faced by the United States," said study author Dr. Christine Durand.
"In 2000," she added, "only one in every 100 deceased donors died from a drug overdose. Today, that number is more than one in every 10 deceased organ donors."
That amounts to a 24-fold increase over the past 18 years.
And after tracking nearly 20,000 transplants involving organs received from patients who overdosed between 2000 and 2017, Durand said that her team found that "patients who received transplants from these donors had excellent outcomes, patient survival and organ function that were similar to cases when donors died due to trauma, and similar or better than cases when the donor died due to medical causes of death like heart attack or stroke."
Durand is an assistant professor at the Johns Hopkins University School of Medicine in Baltimore, and serves as a transplant infectious diseases physician with the hospital there.
Organs are in short supply. In 2017, more than 120,000 patients were on national organ donor waitlists. Only about 10,000 actually received an organ, the researchers said.
At the same time, the 52,000 deaths resulting from a drug overdose in 2015 represented a tripling since 2000. And while just about 1 percent of all organ donations were attributed to overdose deaths in 2000, that figure climbed to more than 13 percent by 2017, the investigators found.
The new analysis reviewed transplant registry data on approximately 10,000 kidneys, 5,700 livers, 2,500 hearts, and 1,400s lungs from overdose victims. Such donors were more likely to be white, from the Midwest and Northeast, and between the ages of 21 and 40.
Overdose donors were also more likely to have had hepatitis C or be tagged with an "increased infection risk" label. Specifically, 18 percent and 56 percent had hepatitis C or were labeled risky, respectively, over the study period.
This compared with 3 percent and 14 percent among trauma donors, respectively, and 4 percent and 9 percent among natural cause donors, respectively, the findings showed. Durand noted, however, that hepatitis C appears to be increasingly common among overdose donors, rising from just 8 percent in 2000 to 30 percent today.
The findings were published online April 16 in the Annals of Internal Medicine.
Durand said that "there are no formal restrictions with respect to the use of organs from donors who die from drug overdose." Still, roughly 2,300 organs from overdose victims were discarded between 2000 and 2017. That was largely due to a confirmed hepatitis C infection or fears regarding HIV and hepatitis exposure due to risky behaviors, such as injection drug use.
Ultimately, the investigators found that "in all comparisons of organ types and donor types, that transplants using overdose death donors were non-inferior," Durand said.
"This means that patients and their physicians who are considering accepting an organ from someone who died of an overdose can expect good outcomes," she added.
In fact, she said that given organ shortages, "we believe the number of discarded organs from overdose death donors should be lower," noting that the "true risk" for being infected from "infectious-risk donors" is less than one in 1,000 for hepatitis C and one in 10,000 for HIV.
"The current epidemic of deaths from overdose is tragic," Durand acknowledged. "It would also be tragic to discard lifesaving organs donated for transplant. We have an obligation to optimize the use of all organs donated. The donors, families and patients waiting deserve our best effort to use every 'gift of life' we can."
Dr. Camille Nelson Kotton is clinical director of transplant and immunocompromised host infectious diseases at Harvard Medical School's infectious diseases division, in Boston.
She agreed that the findings "confirmed what we hoped might be true -- that using these donors did not increase the risk of organ transplantation." Kotton wrote an editorial that accompanied the study.
"I do believe the potential transplant recipients should feel confident that such donations are likely to benefit them," Kotton added. "I would be comfortable accepting an organ from an overdose death donor for myself or a loved one."
There's more on organ donations at the U.S. Department of Health and Human Services.
SOURCES: Christine Durand, M.D., transplant infectious diseases physician, Johns Hopkins OR, and assistant professor, Johns Hopkins University School of Medicine, Baltimore; Camille Nelson Kotton, M.D., clinical director, transplant and immunocompromised host infectious diseases, infectious diseases division, and Harvard Medical School, Boston; April 16, 2018, Annals of Internal Medicine, online