Fatal Opioid Overdoses Provide 'Favorable' Organ Donors

A new study challenges the rationale used to reject the use of vital organs harvested from deceased opioid users. 

One morbid benefit of the long and deadly opioid epidemic that claims tens of thousands of lives every year in the United States is an increase in available human organs for transplant.

Now, a new study in The Annals of Thoracic Surgery shows that the hearts removed from overdose death donors (ODD), who often tend to be younger and healthier, provide "favorable heart donor quality" and as-good-or-better outcomes than organs harvested from donors who died from other causes.  

"One of the roles of the transplant community is to at least partially mitigate the tragedy of this exponentially growing problem by maximizing the utilization of organs from ODD," said study lead author Nader Moazami, MD, of NYU Langone Health in New York, in accompanying remarks.

Using data from the Scientific Registry of Transplant Recipients for the years 2000 to 2017, Moazami's researchers looked at trends in organ donation and transplants among drug overdose deaths.

Of the nearly 16,000 heart transplants from adult donors during this period, opioid overdoses (10.8%) were the fourth most common cause of death, behind blunt injury (30.5%), hemorrhage/stroke (22.1%), and gunshot wound (18.3%).

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The statistics from the opioid epidemic are staggering. More than 700,000 people died from drug overdoses between 1999 and 2017, including about 400,000 people who overdosed on an opioid. More than two-thirds (68%) of the nation's 70,200 drug overdose deaths in 2017 involved an opioid. On average, 130 people die every day in the United States from an opioid overdose, according to statistics cited by the Centers for Disease Control & Prevention.  

In 2017, according to Moazami's research, overdoses accounted for more than 20% of donor deaths in 11 states. In 2000, the highest state's rate was 5.6% and 33 states had less than 1% of donor deaths attributed to overdoses.

A record 36,500 organ transplants were performed in 2018, and 3,400 of those were heart transplants. Even with the influx of new donors, however, the demand for vital organs far outstrips the supply. On average, 18 people died every day waiting for an organ transplant in 2017, according to the United Network for Organ Sharing. 

The researchers also saw a hike in the percentage of transplants that utilized ODD hearts: 1.1% in 2000; 6% in 2012; and 14.2% in 2017. The current rate of ODD utilized for heart transplantation is 16.9%, a 14-fold increase from 2000.

"The dramatic increase in the rate of ODD utilization was striking, and it has increased concordantly with the rate of overdose deaths," Moazami said. "The significant impact of the opioid epidemic on transplantation is one of the major reasons that organ transplant numbers have increased over the last several years."

Donors who died from opioid overdoses were often younger than age 40 and had higher rates of substance abuse. They also had lower rates of diabetes and hypertension. Because of that, Moazami said that ODD organs had "favorable heart donor quality" and as-good or better outcomes than non-overdose organs.

"We do not believe that overdose status alone is a valid reason to discard an otherwise viable donor heart, and this study supports that ODD organs should not be rejected due to inappropriate bias," he said.

"With no significant difference in survival between ODD and non-ODD recipients, further expansion of this donor pool may be appropriate, with more hearts potentially used for transplantation," he said.

The opioid epidemic has also increased the numbers of other vital organs available for donation, Moazami said. ODD provided 7% of the transplanted lungs from 2010-2017, up from 2% in 2000-2007. And as with the findings on the heart donors, the research suggests that ODD lungs are not an extra safety concern for recipients.

The recent surge in hepatitis C contamination and its correlation with drug use has raised concerns about the safety of using organs from overdose death donors. Moazami said that medical advances and sophisticated testing have minimized the risks of transplanting an infected organ.

Robert S.D. Higgins, MD, surgeon-in-chief of The Johns Hopkins Hospital in Baltimore, who was not involved in the study, said Moazami's findings "highlights the need for additional research in this area to further define the 'risk' as well as the reward of expanding the donor pool to save more lives."