More than 13% of all organs transplanted in the US now come from people who died of a drug overdose, up from about 1% in 2000, according to a study released Monday.
Transplant centers have historically been wary of organs donated from drug users because of the risk that the person carried an infectious disease such as HIV. But the new study showed that people who get organs from overdose victims live at least as long as those who get organs from accident victims, and even slightly longer than those who get organs from older donors who die of natural causes.
The shift in the organ donor population toward overdose victims is “another staggering statistic that shows how tragic the opioid crisis is,” study lead author Christine Durand of the Johns Hopkins University School of Medicine told BuzzFeed News.
Roughly 115,000 people are on a waiting list for a donor kidney, liver, or other organ. Given the shortage of transplant organs, Durand said, “we should work hard to honor the wishes of people who overdosed to use every gift of life we can.”
In their study, Durand and her colleagues looked at 340,000 US transplant surgeries between 2000 and 2017. Over that time period, donations increased about 25%, from roughly 12,000 donors in 2000 to 16,000 in 2016.
Overall, the study found that people who get an organ from an overdose victim had a five-year survival rate — 86% — as good as people who received theirs from a trauma victim, and slightly better than the 81% five-year survival of those who received organs from someone who died of a stroke, heart attack, or other natural cause.
Organs transplanted from drug users were labeled as an infectious disease risk 56% of the time, about twice the rate of other donated organs, which Durand said might needlessly scare patients away from the organs. The incidence of hepatitis C has increased among organ donors who died of drug overdoses, from 8% in 2000 to 30% in 2017. But new antiviral drugs that can end that infection have worked in some pilot studies of organ transplants.
Saying no to an available organ has its own risks. For example, among people on transplant waiting lists who declined a kidney because of its infectious disease risk, only 31% received a different kidney in the next five years. Around 11,000 people die every year on the transplant waiting list.
Transplant experts agreed the tragedy of the overdose crisis outweighs any silver lining from increased organ donations.
“We all would rather see the opioid epidemic end, even if it meant fewer transplants,” David Goldberg, medical director for Living Donor Liver Transplantation at the Hospital of the University of Pennsylvania, told BuzzFeed News. “However, I like to think that being able to save another person's life through organ transplantation may provide some solace to the families of those dying of a drug overdose.”
Before transplant centers push transplant patients to use more organs from overdose victims, however, they should be completely transparent about possible bad consequences, bioethicist Arthur Caplan of New York University's Langone Medical Center told BuzzFeed News. Although the study shows good survival rates at five years, he said, it doesn’t tell transplant patients about their odds of organ failure after that time. And the good results with antiviral drugs are still early results.
Using these organs more often might also raise questions of cost and fairness, Caplan said, if only certain transplant recipients can afford expensive antiviral treatments, which can cost tens of thousands of dollars.
Another area of improvement would be monitoring patients after transplant surgeries, an editorial accompanying the study suggested. Only about 60% of people who received organs designated as infectious disease risks received medical monitoring afterward, according to a 2013 survey.
Altogether, the number of organs donated from overdose victims is impressive because illicit drug users include people outside the profile of the typical organ donor, with higher rates of homelessness, unemployment, and poverty, Caplan noted.