We Should Be Transplanting More Organs from Individuals Who Died of Drug Overdose / by F. Perry Wilson

Organs from donors who died from overdose are "discarded" more than from other donors. That might not be the right choice.

Imagine you are a dialysis patient. Three days a week, you spend 4 hours in a chair hooked up to a dialysis machine. You’ve been on the transplant waitlist for 4 years.  Finally, you get the call. There’s a kidney for you. But the donor died due to a drug overdose. Do you say yes?

This phone call is coming more and more frequently as the opioid epidemic continues to claim lives. But until now, we didn’t have enough data to inform an answer to the question.  Now this paper, appearing in the Annals of Internal Medicine suggests very strongly that if you (or your patient) gets that call, you should say yes.

Researchers used data from the Scientific Registry of Transplant Recipients which records data from every organ transplant in the US, including the donor’s cause of death.

 Causes of death in organ donors, 2000-2017

Causes of death in organ donors, 2000-2017

The “ideal” donor – though ideal doesn’t feel like the right word here– is a young, healthy individual who suffered brain death due to trauma. As you can see from the chart, roughly 40% of donors met that criteria, while 55% died due to medical causes.

Over the 17 years examined in the study, just around 5% of donors had died from an overdose, but that number has skyrocketed recently.

In the year 2000, 1% of organ donors had died of overdose. Today, 13.4% of donors have died from an overdose. And in areas endemic for opioid abuse, that number is even higher – it’s around 35% in Massachusetts right now.

 Kaplan-Meier curves showing equivalent survival, regardless of the provenance of the organ.

Kaplan-Meier curves showing equivalent survival, regardless of the provenance of the organ.

 Organs from those who overdosed are more likely to be discarded

Organs from those who overdosed are more likely to be discarded

Once an organ donor is identified, organs are procured, but that’s not the end of the story. Some organs never find a willing recipient – these become “discards” and the data clearly shows, even after adjustment for multiple factors, that organs from those who died of drug overdoses are discarded more frequently than organs that come from trauma patients.

But is that evidence of smart practice, or just bias? Are these bad organs?

The authors argue that these organs are perfectly fine, based on the fact that the organs from donors after drug-overdose do just as well as organs from individuals who died after trauma.

 The chasm between those waiting for transplant, and those who receive one

The chasm between those waiting for transplant, and those who receive one

In other words, we may be discarding these organs inappropriately, and given the necessity to increase the organ pool (there are 120,000 individuals on organ wait lists and just over 10,000 donors in 2017), we should make efforts to increase transplantation rates among individuals who died of drug overdoses.

Now we need to be a bit careful here. Maybe the overdose organs that get transplanted do so well because physicians and patients are being so picky about them. It’s reasonable to think that individuals may only be willing to accept an organ from a donor who overdosed if it is essentially perfect in every other way. 

But data like this helps us make better choices – it moves us from conjecture and gut instinct to hard evidence, and in this case the evidence is leading us to give these organs a second look.