Public Release: 

Optimizing the use of organs donated from overdose deaths

American College of Physicians

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information.

1. Optimizing the use of organs donated from overdose deaths could help to address the national organ shortage

The number of organs donated from overdose deaths has increased 24-fold since 2000

Abstract: http://annals.org/aim/article/doi/10.7326/M17-2451

Editorial: http://annals.org/aim/article/doi/10.7326/M18-0720

URLs go live when the embargo lifts

The number of organs donated as a result of overdose death has increased 24-fold since 2000 and transplants with those organs have similar outcomes to transplants with organs donated after trauma or natural death. Optimizing their use is not a solution to the organ shortage, but it could help to address the problem. Findings from a National Registry study are published in Annals of Internal Medicine.

Overdose deaths in the U.S. have nearly tripled over the past 15 years, with 52,404 deaths reported in 2015. At the same time, the U.S. has a severe shortage of organ donors for transplant, with more than 120,000 patients on national waitlists but only 10,281 donors in 2017. For many, the risk for death while on the waitlist is greater than the chance of receiving an organ. Understanding the viability of organs transplanted from overdose deaths could inform decision-making and potentially help to address the shortage issue.

Researchers from Johns Hopkins University School of Medicine used data from the Scientific Registry of Transplant Recipients to characterize organ donors who died of overdose and to analyze outcomes in patients who received those organs. Their analysis included 138,565 deceased donors and 337,934 solid organ transplant recipients between 2000 and 2017. The authors found that overdose-death donors transplants increased substantially from about 1 percent of donors in 2000 to over 13 percent in 2017. Outcomes in patients with organs donated from overdose death were noninferior to those obtained from other types of donors and, in some cases, were better. Compared with medical-death donors, overdose-death donors were less likely to have hypertension, diabetes, or prior myocardial infarction but had slightly higher creatinine levels and were more likely to donate after circulatory death.

According to the authors, HIV, hepatitis B virus, and hepatitis C virus transmission are a concern with overdose-death organs and, therefore, they are discarded at a higher rate than those from trauma-related death. In this study, 56 percent of the organs were from increased-risk donors, which is twice the proportion among non-overdose-death donated organs nationally. However, with viral nucleic acid and antibody testing, the true risk for a window-period infection for increased-infectious risk (IRD) organ recipients is extremely low. Furthermore, candidates who accept IRD kidneys have a better survival rate than those who wait for another organ. The authors caution that small potential risks attributable to IRD and HCV status should be carefully weighed against the benefit these organs can provide to transplant candidates.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview with the lead author, Christine M. Durand, MD, please contact Chanapa Tantibanchachai at chanapa@jhmi.edu or 410-502-9433.

2. Package inserts for opioid pain relievers lack consistent and explicit messaging about safe storage and disposal

Abstract: http://annals.org/aim/article/doi/10.7326/M17-3381

URLs go live when the embargo lifts

Package inserts for opioid pain relievers lack consistent and explicit messaging about safe storage and disposal. Findings from a brief research report are published in Annals of Internal Medicine.

Medication diversion, or illicit use of a medication by an individual to whom it was not prescribed, represents the largest source of misused opioid pain relievers. Unused opioid analgesics are seldom safely stored or disposed of, creating a large supply for diversion. Package inserts offer an opportunity to educate providers and promote safe storage and disposal messages to patients.

Researchers from the Johns Hopkins Bloomberg School of Public Health's Center for Injury Research and Policy reviewed package insert information for 6 commonly prescribed and misused opioid pain reliever types, including hydrocodone, hydromorphone, tramadol, fentanyl, morphine, and oxycodone. From a random sample of 98 inserts, the reviewers found one safe storage message and three different types of safe disposal messages. Approximately two-thirds of the 35 package inserts with the safe storage message were for oxycodone or morphine products. Similarly, 70 to 80 percent of package inserts with a safe disposal message were oxycodone or morphine products. None of the inserts for tramadol products had either storage or disposal messages and only one of the 33 package inserts for hydrocodone products had a storage or disposal message.

While the presence of safe storage and disposal information within package inserts was promising, the researchers found that it was inconsistent across pain reliever types and infrequent or absent for some products. They suggest that policymakers consider mandating the inclusion of safe storage and disposal information on opioid pain relievers package inserts.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Mitchell L. Doucette, PhD, MS, please contact Susan Murrow at Smurrow1@jhu.edu or 410-955-7624.

3. Internists Say Social Determinants of Health Play Role in Improving Patient Care and Promoting Health Equity

Note: HD video soundbites of ACP's president discussing this paper are available to download at http://www.dssimon.com/MM/ACP-social-determinants

Free content: http://annals.org/aim/article/doi/10.7326/M17-2441

Editorial: http://annals.org/aim/article/doi/10.7326/M18-0335

URLs go live when the embargo lifts

A new policy paper from the American College of Physicians (ACP) recommends ways to promote health equity by addressing social determinants of health, or those conditions that affect a patient's daily life, such as income, social status, education, and physical environment. Social Determinants to Improve Patient Care and Promote Health Equity is published in Annals of Internal Medicine.

ACP recommends increasing awareness of social determinants of health through increased funding of federal, state, and local programs that aim to address social determinants of health, including investments in programs and social services, as well as dedicating more research into the causes and effects of social determinants of health. Additionally, ACP urges Congress and the administration to implement policies that reduce socioeconomic and environmental inequalities that significantly impact patient health, with an increased focus on wellness and prevention.

Health disparities, often rooted in social, economic, and environmental factors, can influence an individual's health. On average, there is a 15 year difference in life expectancy between the most advantaged and disadvantaged citizens. While addressing social determinants of health alone may not always result in better health care outcomes, it is a critical step forward in solidifying physicians' roles as advocates for patients.

Promoting health equity and reducing significant health disparities is a longstanding goal of ACP. In order to reduce our country's sizable health disparities, ACP's paper calls for awareness of social determinants of health to be incorporated into medical education at all levels--from medical school to residency--to help all patients get the care they need, not just a select few.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. For comment from ACP, please contact Julie Hirschhorn at jhirschhorn@acponline.org or 202-261-4523.

4. ACP Calls for Gender Equity in Physician Compensation and Career Advancement

Free content: http://annals.org/aim/article/doi/10.7326/M17-3438

Editorial: http://annals.org/aim/article/doi/10.7326/M18-0837

URLs go live when the embargo lifts

The American College of Physicians (ACP) examines ways to achieve gender equity in the medical profession in a new policy paper published in Annals of Internal Medicine. Achieving Gender Equity in Physician Compensation and Career Advancement provides a set of recommendations aimed at addressing the challenges women in medicine face, including equity in physician compensation, career advancement, and bias. In the paper, ACP recommends:

  • Ensuring that physician compensation is equitable, and that no physician should be penalized for working less than full time.

  • Supporting universal access to family and medical leave policies that provide a minimum period of six weeks leave for physicians, residents and medical students, and recommends that six weeks paid leave become a standard part of any physician or resident's benefit package regardless of gender.

  • Urging all organizations that employ physicians to take steps to increase the number of women in leadership positions.

  • Investing in further research on the impact of gender compensation inequity and barriers to career advancement and best practices to close these gaps across all practice settings.

  • Implementing regular implicit bias training by all organizations that employ physicians.

  • Establishing programs in leadership development, negotiation, and career development for all physicians and physicians in training.

Promoting gender equity and eliminating the inequities in compensation and career advancement that physicians can face is a longstanding goal of ACP. In order to foster an inclusive environment that promotes growth and development for female physicians, ACP's paper calls for the adoption of equitable compensation policies in all organizations that employ physicians, investment in leadership development, negotiation and career development programs, and parental and family leave policies.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. For comment from ACP, please contact Julie Hirschhorn at jhirschhorn@acponline.org or 202-261-4523.

Also new in this issue:

The Need for Closed-Loop Systems for Management of Abnormal Test Results
Gianna Zuccotti, MD; Lipika Samal, MD, MPH; Francine L. Maloney, MPH; Angela Ai, BA; and Adam Wright, PhD
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M17-2425

The Short-Lived Epidemic of Botulism From Commercially Canned Foods in the United States, 1919 to 1925
Powel Kazanjian, MD, PhD
History of Medicine
Abstract: http://annals.org/aim/article/doi/10.7326/M17-2853

An Apple a Day
Annals Graphic Medicine
Full text: http://annals.org/aim/article/doi/10.7326/G18-0003

If You Can't Beat It, Join It: Uncertainty and Trust in Medicine
Katrina Armstrong, MD, MSCE
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M18-0445

Creating Entrustable Professional Activities to Assess Internal Medicine Residents in Training: A Mixed-Methods Approach
David R. Taylor, MD, MHPE; Yoon Soo Park, PhD; Christopher A. Smith, MD; Jolanta Karpinski, MD, MEd; William Coke, MD; and Ara Tekian, PhD, MHPE
Academia and the Profession
Abstract: http://annals.org/aim/article/doi/10.7326/M17-1680

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