The widening tragedy that is the U.S. drug-overdose epidemic could have an improbable silver lining: for the 120,000 desperate Americans on the waiting list for a donated organ, the line could get a little shorter.
In 2000, only 149 organs from donors who suffered a fatal drug overdose were transplanted into patients waiting for a replacement kidney, heart, liver or lungs. In 2016, overdose victims donated 3,533 such organs for transplant.
For many transplant patients, the increased availability of organs from those who die of drug intoxication has translated into slightly improved survival rates at the five-year mark, according to new research.
Among all prospective organ donors, the youngest and healthiest have generally been those who become brain dead due to trauma — falls, drownings, electrocution, vehicle crashes and violent injuries.
Patients who lose all brain function as a result of stroke, heart attack or brain hemorrhage also become organ donors. But they tend to be older, and their organs are typically in worse shape, often compromised by risk factors like high blood pressure, diabetes and worrisome cholesterol.
As organ donors, victims of fatal drug overdose are a mixed lot. Almost two-thirds are still young — between 21 and 40 — and they’re much less likely than those who died of a stroke or heart attack to have organs worn down by cardiovascular ills. But they’re also more likely than other donors to have serious viral infections like HIV and hepatitis B or C — infections that would likely be passed to a transplant recipient through an infected organ.
Rates of drug-overdose deaths have more than tripled in the United States since 2000, driven by rising addiction to opioids. That grim trend has brought about a 24-fold increase in transplants involving an organ harvested from an overdose victim.
In a study published Monday in the Annals of Internal Medicine, researchers from Johns Hopkins University set out to glean how opioid use has changed the prospects for transplant recipients, and whether these parting gifts from drug abusers were being well used.
To do so, the researchers combed the records of 138,565 deceased organ donors and 337,934 solid organ transplant recipients between 2000 and 2016.
They found that transplant patients who got the hearts or lungs of deceased drug users were between 1% and 5% more likely to be alive after five years than were those who got hearts or lungs from donors who died from trauma or natural causes.
Recipients of a heart or lungs from an overdose victim were also less likely to have rejected those organs than were recipients whose donation came from a patient who died from trauma or natural causes.
Patients who got a kidney or liver from a donor who overdosed were 2% to 3% more likely to survive five years than were patients who got their kidney or liver from someone who died of a medical condition. However, compared to recipients whose liver or kidney came from a trauma victim, those who got a drug user’s kidney or liver fared roughly 3% worse.
For most of the organs studied, the evidence “slightly favors” the use of organs from donors who’ve suffered fatal overdoses over organs from any other donors, the researchers concluded. In any event, they concluded that overdose victims’ organs are not inferior to transplantable organs from other donors.
But some of these newly available organs may be going to waste. Currently, 20 people die every day while waiting for an organ to become available, so the needless disposal of a transplantable organ can be a deadly mistake.
The likely reason for this waste is that, compared to organ donors who died of trauma or of natural causes, those dying of drug overdoses were much more likely to have HIV or hepatitis B or C, or to be labeled “increased infectious risk donors.” (Illicit drug users often share tainted needles and syringes, and they have a propensity toward risky sexual behavior.)
By 2017, close to 30% of organ donors who died of drug overdose were infected with hepatitis C, compared to 3% to 4% of all other organ donors. By 2017, 72% of overdose victims were considered risky disease carriers — a rate that was three to five times higher than for donors who died of trauma or natural causes.
But new tests allow surgeons to glean more quickly whether a prospective donor is actually infected. And with new medications and more aggressive treatment, studies show the prognosis is improving for transplant recipients who do get infected organs.
Still, the stigma, legal concerns and specialized consent procedures for organs donated by overdose victims may make transplant surgeons and patients more reluctant to accept them, the authors wrote. And they get discarded at higher rates than they should.
Make no mistake, the researchers wrote: the epidemic of fatal drug overdoses is a national tragedy, “not an ideal or sustainable solution to the organ shortage.” But while the overdose epidemic rages unchecked, transplantable organs donated by victims’ grieving family members “should be optimized,” they added.
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