Organ donations from overdose deaths could alleviate crisis

Around 20 people in need of an organ transplant die every day while waiting for a match. We need better solutions, but organ transplants come riddled with risks. Can donations from those who died of an overdose provide a partial solution, despite concerns around potential risks?

According to the United States Department of Health and Human Services, over 116,000 U.S. citizens were waitlisted for an organ transplant as of August 2017.

They say that the waiting list lengthens every year, but that the number of organ donations increases at too slow a rate to meet the ever growing need.

Dr. Christine M. Durand — from Johns Hopkins University School of Medicine in Baltimore, MD — has recently led a study focusing on a less intuitive way of addressing this problem: optimizing organ donations from overdose deaths.

Often, such organs — especially the liver and kidneys — are discarded, for fear that they may place the receiver at risk of chronic diseases such as HIV and hepatitis.

Yet Dr. Durand's research suggests that potential receivers face higher risks to their health while stuck on a waiting list.

According to Dr. Durand and her colleagues, from the year 2000 until the present, the number of organs received from donors who died of an overdose has become 24 times larger. So, why not use them more often to supplement the national shortage of donated organs?

The new study — published in the journal Annals of Internal Medicine — analyzes the pros and cons of optimized organ donations collected from individuals who died due to an overdose.

Recipients at lower risk than feared

The team worked with data sourced using the Scientific Registry of Transplant Recipients to build the medical profile of organ donors who died of an overdose and check the survival rates and other health outcomes of individuals who received organs from such donors.

So, they analyzed the data of 138,565 overdose death organ donors, as well as that of 337,934 recipients, available between 2000 and 2017.

In the first instance, Dr. Durand and colleagues noticed that the number of organ donations from individuals who died of an overdose had increased dramatically over the past 17 years, from approximately 1 percent in 2000 to more than 13 percent in 2017.

But even more importantly, they found that the health outcomes of transplant recipients who accepted organs from these donors were also, on the whole, no worse than those for people who received transplants from healthy donors.

In fact, the outcomes for the former set of recipients were sometimes better than those of patients receiving transplants from other donors.

When characterizing overdose death donors compared with medical death donors, the researchers made a few additional observations. The former, it was noted, were less likely to have experienced hypertension, diabetes, or a heart attack.

But at the same time, they had higher levels of creatinine, a natural "waste product" processed by the kidneys. If levels of creatine in the body are too high, this may be an indication that kidney function is impaired.

Dr. Durand and her team also noticed that individuals who died of an overdose were more likely to agree for their organs to be collected for transplant use after circulatory death, in which the heart and the lungs cease to work and their function cannot be restored.

Sometimes, organs that are collected from donors who overdosed are discarded due to fears that certain viruses — such as hepatitis B and C and HIV — that these individuals may have been susceptible to may be transmitted to the recipient.

But the researchers' viral nucleic acid and antibody tests revealed that the true risk for transmission from donor to recipient is, in fact, very low.

And, when it comes to recipients who accept kidneys from donors who present an increased risk of transmission, they actually have a better survival rate than those who choose to pass on this opportunity.

At the same time, though, the researchers warn that recipients and the healthcare professionals who advise them should still weigh potential risks against the benefits gained from accepting organs from non-medical death donors.

Despite any case-by-case misgivings, the researchers nevertheless suggest that overdose death organ donations could provide a viable partial solution to the crisis facing U.S. patients on the waitlist.

"In conclusion, [...] we found that recipients of [overdose death donation] organs had non-inferior patient and graft survival."

"Although this is not an ideal or sustainable solution to the organ shortage," the study authors conclude, "use of [overdose death donation] organs should be optimized."