SALT LAKE CITY — Heart and lung transplants that use donors who died from an opioid overdose lead to the same success rate as is seen with other donors, and fatal overdoses have been the main driver behind an increase in transplants nationwide in recent years, authors of a new study say.
Dr. Josef Stehlik, medical director of the heart transplant program at University of Utah Health, was the senior author of the research, published earlier in May in the peer-reviewed New England Journal of Medicine.
The study examined transplant data in the United States from 2000 to 2016, categorizing what caused donors' deaths and pairing that information with recipient survival rates over one year. Outcomes for 2,360 recipient patients were examined.
Compared to the organs of donors who died from other causes, "no significant difference in survival after transplantation was noted (among) recipients of organs from donors who died from drug intoxication," the study concludes.
"In the unfortunate circumstances in which a … (fatal) drug overdose death takes place, our study indicates use of many of these organs is very safe," Stehlik told the Deseret News. "In the unfortunate circumstances of this patient's passing, multiple lives can be saved if we use these organs."
The study found no statistically significant differences in heart or lung recipient survival rates at increments of one month, up to a year, when compared to other causes of death which combine to make up the majority of all organ donations: intracranial hemorrhage or stroke; blunt head injury; gunshot wound; and asphyxiation, drowning or seizure.
Those findings also held when compared to donations from patients who died as a result of miscellaneous factors besides those common causes.
Stehlik cautioned the results don't mean that every heart and lung associated with an overdose donor is safe to use, but rather that there should be no additional hesitation to move forward with a transplant if a standard test of organ functionality shows they are "likely to perform well and extend lives."
Stehlik said in the past, making decisions about the organs of a potential donor who overdosed, family members or medical professionals adhered to a preconceived "narrative" that their organs would be of no use.
"Those patients, because of their lifestyle and the mechanism of death, historically have been considered higher risk for donation," Stehlik said.
But the new study and others in recent years have begun to show that is not the case, and medical practice is falling in line with that growing understanding, he said.
Prior research has shown similar results indicating it is safe and effective to transplant livers and kidneys from donors who fatally overdosed, he added. The new study set out to examine success rates specifically with hearts and lungs because they are the organs "most likely to suffer from low oxygen flow and low blood pressure during the process of death," Stehlik said.
Total organ donations from those who overdosed "has seen a 17-fold increase in 16 years," Stehlik said. Despite improving practices playing a part in that, "unfortunately the change has been mostly due to the dramatic change in … deaths overall from drug overdose and opioid overdose," he said.
In 2000, just 59 organs of fatal overdose victims were used for transplants in the United States, making up a little more than 1 percent of all such transplants from deceased patients, the study said. In 2016, 1,029 such organs were donated, making up 13.7 percent of all deceased donor transplants.
“We were surprised to learn that almost all of the increased transplant activity in the United States within the last five years is a result of the drug overdose crisis,” said Dr. Mandeep Mehra, another author of the new study and the medical director of the Heart & Vascular Center at Brigham and Women's Hospital in Boston, in a statement.
Because it is linked to the scourge of opioid addiction, Stehlik said, "we can't rely on this increase forever," and don't want to. Speaking on the large scale of opioid addiction across the country, he said, "We hope this will actually be taken care of."
Roughly 600 Utahns died every year from overdosing on opioids between 2013 and 2016, according to data tracked by the health care policy think tank Kaiser Family Foundation.1 comment on this story
In the United States, about 115 people die each day from such overdoses, the National Institute on Drug Abuse says.
"(This study) underscores that need to be very aggressive with all the other efforts to increase organ donation, meaning education of the public as far as potential benefits of organ donation for other patients, regardless of the cause of death, and being quite aggressive with using organs — maybe going into the high ages of donors, etc.," Stehlik said.
Eurotransplant International Foundation and the United Network for Organ Sharing also helped carry out the new research.