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Organs from overdose-death donors could alleviate organ donation shortage

Proper use of organs from people who die of overdose could help address the shortage of organs available for transplant, according to findings recently published in Annals of Internal Medicine.

“Overdose-death donors often experience anoxic brain death and have few comorbidities; thus, their organs could have excellent recipient outcomes, similar to [trauma-death donor] organs,” Christine M. Durand, MD of Johns Hopkins University School of Medicine and colleagues wrote. “However, [overdose-death donors] might be designated as increased–infectious risk donors due to behaviors that increase risk for HIV, hepatitis B virus or hepatitis C virus infection. The [increased–infectious risk donors] label might reduce use of [overdose-death donors] organs because it is associated with organ discard (surgical recovery without subsequent use for transplant).”

“Moreover, [overdose-death donors] are increasingly positive for HCV antibodies and inferior outcomes might be expected due to HCV infection. Finally, concerns that illicit drug use compromises organ quality might exist; for example, injection drug use is associated with lung granulomatosis,” they added.

According to previously published research, increased-infectious risk donors are those deceased possible organ donors at greater risk for specific infectious pathogens based on donor behavioral and demographic characteristics. These donors may be at risk for transmitting certain pathogens despite serology tests that come back negative.

In the Annals of Internal Medicine study, Durand and colleagues attempted to assist clinicians and patients in making decisions involving overdose-death donor donations. They identified 7,313 overdose-death donors and 19,897 overdose-death donor transplants. They found that overdose-death donors were more likely to be white (85.1%), aged 21 to 40 years (66.3%), increased–infectious risk donors (56.4%) and infected with HCV (18.3%).

Researchers reported that standardized 5-year patient survival was similar for organ recipients from overdose-death donors vs. those who received organs from young trauma-death donor, with standardized risk differences of organ recipients ranging from 3.1% lower to 3.9% higher survival, vs. medical-death donor organ recipients, with standardized risk differences ranging from 2.1% lower to 5.2% higher survival).

The standardized 5-year graft survival was similar between overdose-death donor and young trauma-death donor grafts (slightly higher for hearts, slightly lower for livers and miniscule differences for lungs and kidneys). Kidney discard was higher for overdose-death donors than medical-death donors or young trauma-death donors; standardization for HCV and increased–infectious risk donors status attenuated this difference.

“Organ donation after overdose death has increased dramatically in parallel with the opioid epidemic in the United States, and we found that recipients of [overdose-death donors’] organs had noninferior patient and graft survival,” Durand and colleagues wrote.

“Although this is not an ideal or sustainable solution to the organ shortage, use of [overdose-death donor] organs should be optimized. Potential risks attributable to [increased–infectious risk donors] and HCV status should be carefully weighed against the benefit these organs can provide to transplant candidates.”

In a related editorial, Camille Nelson Kotton, MD, of Massachusetts General Hospital and Harvard Medical School, wrote that the study’s findings highlight an opportunity that should not be ignored by the medical community.

“We need to save more lives of persons awaiting organ transplant. Durand and colleagues demonstrate noninferior (and sometimes even superior) outcomes with [overdose-death donor] organs. The use of [increased–infectious risk donor] organs results in substantial long-term survival benet, and the rate at which they are discarded (20% for kidneys in 2016) must be reduced,” she wrote.

“Early discussions with recipients and families that include data such as those in this article, with signicant weight given to the risk associated with declining organs from [increased–infectious risk donors] and [overdose-death donors], can better frame future organ offers. The transplant community should understand these new data and forge ahead toward better transplant outcomes for more recipients.” – by Janel Miller

Disclosure: Healio Family Medicine was unable to determine authors’ relevant financial disclosures prior to publication.

Reference: Blydt-Hansen T, et al. Transplantation. 2014;doi: 10.1097/TP.0000000000000251