Organs from overdose-death donors are increasing and viable

A new study in the Annals of Internal Medicine shows that the rise in opioid-related drug overdoses in the United States is having a significant effect on the number of viable organs available for transplantation.

The number of overdose deaths in the United States has nearly tripled over the past 15 years. During the same period, there has been a marked shortage of available organs for transplantation.

Younger adults are disproportionately more likely to die from an overdose than older adults, and the deceased often suffer anoxic brain death with few comorbidities. In theory, the outcomes from transplanting organs from overdose-death donors (ODDs) should be comparable with those from young trauma-death donors (TDDs) who donate after brain death.

However, organs from ODDs may be classified as increased-infectious risk donors (IRDs) because of behaviors that raise the risk for hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV. Recently, more organs from ODDs have tested positive for HCV antibodies.

Researchers led by Christine M. Durand, MD, assistant professor of medicine and oncology at Johns Hopkins University School of Medicine, Baltimore, MD, reviewed data from the Scientific Registry of Transplant Recipients and identified 337,934 patients who received an organ transplant from a deceased donor between 2000 and 2017. They sought to analyze the outcomes from ODD, TDD, and medical-death donors (MDDs) organs.

About 7,300 ODDs who donated at least one organ were identified in the study. Results showed that the use of ODD organs increased from 1.1% of donations in 2000 to 13.4% in 2017. The donors were more likely to be white (85.1%), aged 21 to 40 years (66.3%), HCV-positive (18.3%), and classified as IRDs (56.4%).

Unadjusted 5-year patient survival was similar between ODD and TDD organs (86.3% vs 86.2%, respectively). The survival rate for MDDs was 80.7%. After standardization, the data showed rates of 83.1%, 86.2%, and 81.0% for ODD, TDD, and MDD transplants, respectively.

The percentage of organs recovered and subsequently discarded was higher in ODDs than TDDs, but lower than MDDs for all organs except lungs. The authors state that this result is most likely related to IRD designation and the higher prevalence of HCV infection among ODDs. However, they note that IRD is a behavioral designation, and that the true risk for infection from IRD organs is extremely low.

“Furthermore, candidates who accept IRD kidneys have better survival than those who wait for another organ,” the authors wrote. “Despite this survival benefit, IRD kidneys continue to be discarded; this may be driven by administrative burdens of specialized consent, medical-legal concerns, or stigma associated with the IRD designation.”

The authors suggest that the increased likelihood of IRD organs being discarded may lead to the unnecessary loss of viable organs.

In an accompanying editorial, Camille Nelson Kotton, MD, clinical director, Transplant and Immunocompromised Host Infectious Diseases, Infectious Diseases Division, Massachusetts General Hospital and Harvard Medical School in Boston, MA, wrote: “We need to save more lives of persons awaiting organ transplant. Durand and colleagues demonstrate noninferior (and sometimes even superior) outcomes with ODD organs. The use of IRD organs results in substantial long-term survival benefit, and the rate at which they are discarded must be reduced.”

To read more about this study, click here.