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

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

AUTHORS: Christine M. Durand, Mary G. Bowring, Alvin G. Thomas, Lauren M. Kucirka, Allan B. Massie, Andrew Cameron, Niraj M. Desai, Mark Sulkowski, Dorry L. Segev

JOURNAL: Ann Intern Med. 2018 Apr 17; DOI: 10.7326/M17-2451


Background: The epidemic of drug overdose deaths in the United States has led to an increase in organ donors.

Objective: To characterize donors who died of overdose and to analyze outcomes among transplant recipients.

Design: Prospective observational cohort study.

Setting: Scientific Registry of Transplant Recipients, 1 January 2000 to 1 September 2017.

Participants: 138 565 deceased donors; 337 934 transplant recipients at 297 transplant centers.

Measurements: The primary exposure was donor mechanism of death (overdose-death donor [ODD], trauma-death donor [TDD], or medical-death donor [MDD]). Patient and graft survival and organ discard (organ recovered but not transplanted) were compared using propensity score–weighted standardized risk differences (sRDs).

Results: A total of 7313 ODDs and 19 897 ODD transplants (10 347 kidneys, 5707 livers, 2471 hearts, and 1372 lungs) were identified. Overdose-death donors accounted for 1.1% of donors in 2000 and 13.4% in 2017. They were more likely to be white (85.1%), aged 21 to 40 years (66.3%), infected with hepatitis C virus (HCV) (18.3%), and increased–infectious risk donors (IRDs) (56.4%). Standardized 5-year patient survival was similar for ODD organ recipients compared with TDD organ recipients (sRDs ranged from 3.1% lower to 3.9% higher survival) and MDD organ recipients (sRDs ranged from 2.1% to 5.2% higher survival). Standardized 5-year graft survival was similar between ODD and TDD grafts (minimal difference for kidneys and lungs, marginally lower [sRD, −3.2%] for livers, and marginally higher [sRD, 1.9%] for hearts). Kidney discard was higher for ODDs than TDDs (sRD, 5.2%) or MDDs (sRD, 1.5%); standardization for HCV and IRD status attenuated this difference.

Limitation: Inability to distinguish between opioid and nonopioid overdoses.

Conclusion: In the United States, transplantation with ODD organs has increased dramatically, with noninferior outcomes in transplant recipients. Concerns about IRD behaviors and hepatitis C among donors lead to excess discard that should be minimized given the current organ shortage.

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