Double-Edge Sword of Drug Epidemic Interview with:
Christine Marie Durand, M.D
Assistant Professor of Medicine
Johns Hopkins Medicine What is the background for this study

Response: Most Americans know that the United States faces an epidemic of deaths due to drug overdose.  And many are also aware that there is a critical shortage of organs available for transplant.  Perhaps less widely known is that today, more than 1 in every 8 deceased organ donors died from a drug overdose.  The objective of our study was to look at the outcomes of patients who received transplants with organs donated after an overdose. What are the main findings?

Response: We found that there has been a dramatic increase in the number of transplants using organs from overdose death donors, growing from 149 transplants in 2000, to 3533  in 2016, totaling 19,897 transplants as of September 2017.  Patients who received transplants from these donors had excellent outcomes; patient survival and organ function 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.

What was surprising was, despite the good outcomes we see in transplant recipients, many organs donated after overdose death were discarded – that is they were surgically recovered but then not used for transplant in any patient.  Our study found this discard was primarily related to an increasing prevalence of hepatitis C infection among overdose death donors and increased infectious risk.

In our study, 56% of overdose death donors were labeled as increased infectious risk donors.  These donors require specialized testing for HIV and hepatitis as well as specialized consent for the transplant recipient.  In reality, the “increased risk” of HIV or hepatitis in these donors is very low: < 1/10,000 for HIV and < 1/1000 for hepatitis and studies demonstrate that patients who accept increased risk donors have better survival than those who wait for a standard risk donor.  However, there is stigma related to this increased infectious risk label. Despite the survival benefit, increased infectious risk donor organs continue to be discarded at high rates.  This needs to change.
Mary Grace Bowring, who is first author on this study with me, recently looked at this in a paper called “Turn Down for What?” that was published in the American Journal of Transplantation last month.  She showed that patients who accept organs from increased infectious risk donors have a 48% lower risk of death than those who wait for another offer.

With transplant, you always have to balance the risk and benefit.  There is a critical shortage of organs and the biggest risk for many patients is not receiving a transplant at all.  Patients and their transplant teams have to weigh the small risk of an infection like hepatitis C – for which we now have a cure – against the risk of dying on the waitlist – which is a real risk. What should readers take away from your report?

Response: For people waiting on an organ transplant right now, I would like to think that our studies bring them hope that they could receive a transplant, and have more donors that could help them.

For healthcare providers, I would like them to know that the deceased donor pool includes overdose death donors and infectious disease risk donors who donate organs, and that these organs are a safe and underutilized public health resource. What recommendations do you have for future research as a result of this work?

Response:  I think we need to better understand the reasons that patients and providers may be declining organ offers and discarding organs from these donors.   Dr. Camille Kotton from Mass General Hospital/Harvard Medical School wrote a great editorial accompanying the study and pointed out that  “National and local support and campaigns for improving issues around specialized consent, medical-legal concerns, and stigma associated with increased infectious risk donors and overdose donor transplants would likely save many lives,” and “Early discussions with recipients and families that include data such as those in this article, with significant weight given to the risk associated with declining organs from infectious risk donors and overdose death donors, can better frame future organ offers. Is there anything else you would like to add?

Response: We should not overlook the people who made these transplants possible: the donors and their families. In a time of tragedy, they made a powerful decision to save the lives people waiting on a transplant. This is a generous, compassionate decision and one I admire.  These are the people who make organ donation and transplantation possible.
The increasing number of overdose death donor organs is not an ideal or sustainable solution to the national organ shortage. The current epidemic of deaths from overdose is a tragedy. It would also be tragic to continue to underutilize life-saving transplants from donors.  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. 


The Drug Overdose Epidemic and Deceased-Donor Transplantation in the United States A National Registry Study 

Annals of Internal Medicine — | April 23, 2018

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Last Updated on April 24, 2018 by Marie Benz MD FAAD