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Opioid epidemic linked to increase in organ recovery
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The U.S. opioid epidemic has been associated with a sharp increase in the recovery of organs from brain-dead donors, according to a letter to the editor published in The New England Journal of Medicine.
Mandeep R. Mehra, MD, professor of medicine at Harvard Medical School and medical director of the Heart and Vascular Center at Brigham and Women’s Hospital, and colleagues said U.S. data indicate that survival among recipients of allografts from donors who died from drug intoxication is similar to survival among recipients from donors who died from other causes, but these data are not consistent in European countries.
“We wanted to understand the impact of the drug-abuse epidemic on the most vulnerable segments of organ transplants, which include heart and lung organs,” Mehra said in a press release. “Importantly, we were curious to understand if the drug-abuse epidemic is affecting organ donations globally or if this effect is restricted to the United States. We were surprised to find that this is a U.S. issue and not at all seen in the European transplant experience.”
The effect of drug intoxication-related deaths on organ donation and outcomes after transplantation were studied via data analysis on donors and transplantation for 17 years in the U.S. compared with the Eurotransplant database. The proportion of recovered organs that were from adult donors who died because of drug intoxication was ascertained by Mehra and colleagues.
Survival rates after heart or lung transplantation were examined among the recipients of such allografts because of the sensitivity to ischemic injury of the organs caused by hypoxia or hypotension.
The researchers described differences in organ recovery over time and constructed a multivariable Cox regression model to assess the independent effect of donor cause of death on posttransplantation survival. Monthly survival was estimated by the Kaplan-Meier method and interpolated linearly.
The researchers found that at least one solid organ was recovered from 103,805 adult brain-dead donors in the U.S. and from 27,661 adult brain-dead donors in Eurotransplant from 2000 to 2016.
Among those in the U.S. cohort, there was a large increase in the proportion of organ donors who died from drug intoxication, from 1.2% in 2000 to 13.7% in 2016 (P < .001). The shift accounted for much of the increase in organ transplantation activity in the past 5 years in the U.S., according to Mehra and colleagues.
By comparison, there was no significant change over time in the frequency of drug intoxication as the cause of donor death ( 1% in any year) and no significant change in overall number of organ donors (1,566 in 2000 and 1,421 in 2016) within Eurotransplant.
The 1-year survival rate after heart or lung transplantation in the U.S. was compared between recipients of organs from donors who died from drug intoxication and recipients of organs from donors who died from other causes.
The researchers found no significant difference in survival after transplantation between recipients of organs from donors who died from drug intoxication and recipients from donors who died from blunt head injury (for heart transplantation: HR = 0.85; 95% CI, 0.71-1.02; for lung transplantation: HR = 0.87; 95% CI, 0.72-1.06) after adjusting for baseline characteristics, and they found similar results for comparisons involving other causes of death among donors.
“It’s important to remember that while more people are receiving the gift of life, other lives are being lost,” Mehra said in the release. “Instead of scientific advancements driving an increase in the pool of available organs, this increase is driven by a crisis, and we cannot rely on this as a source indefinitely. As efforts in health policy to overcome this crisis take root, the transplant community must turn to sustainable ways to increase organ donor recovery.” by Dave Quaile
Disclosure: Mehra reports he receives personal fees from Abbott, Bayer, Janssen, Medtronic, Mesoblast, NuPulseCV and Portola. Please see the study for a list of the other authors’ relevant financial disclosures.
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