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Opioid crisis leads to rise in viable hearts and lungs for those awaiting transplants

Heart or lung transplants from donors who died of drug intoxication show similar survival outcomes as others; Sharp increase in recovered organs driven by drug-abuse epidemic in the US, but not Europe

Brigham and Women's Hospital

Last year, a record number of heart transplants were performed in the U.S., but analyses of the data show a dark reason behind this good news: A sharp rise in organ donations is largely driven by the U.S. drug-abuse epidemic. A new study published in The New England Journal of Medicine by investigators from Brigham and Women's Hospital and University of Utah, examines survival outcomes for patients who have received organs from donors who died of drug intoxication. The team reports no significant difference in survival outcomes among patients who received heart and lung transplants from donors who died of drug intoxication, despite these organs being especially sensitive to restrictions in blood supply.

The study also compares donations in the U.S. and Europe. The team saw a jump in the number of organ donors in the U.S. who had died from intoxication - from 59 in the year 2000 to 1,029 in 2016. Over the same span of time, there was no significant change in the number of organ donor deaths from intoxication in Europe.

"We wanted to understand the impact of the drug abuse epidemic on the most vulnerable segments of organ transplants, which include heart and lung organs," said Mandeep R. Mehra, MD, FACC, FESC, FHFSA, FRCP, executive director of the Center for Advanced Heart Disease and medical director of the Heart & Vascular Center at BWH. "Importantly, we were curious to understand if the drug-abuse epidemic is affecting organ donations globally or if this effect is restricted to the United States. We were surprised to find that this is a U.S. issue and not at all seen in the European transplant experience."

Survival rates one year after heart or lung transplantation were similar for recipients who received organs from donors who died from drug intoxication and for those who received organs from donors who died of other causes.

"It's important to remember that while more people are receiving the gift of life, other lives are being lost," said Mehra. "Instead of scientific advancements driving an increase in the pool of available organs, this increase is driven by a crisis, and we cannot rely on this as a source indefinitely. As efforts in health policy to overcome this crisis take root, the transplant community must turn to sustainable ways to increase organ donor recovery."

Investigators at BWH and elsewhere are currently exploring ways to recover organs from current donors considered less suitable. Some of the novel sources being considered are high-risk organs from donors infected with treatable diseases such as hepatitis C or those from donors who experienced cardiac death.

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Paper cited: Mehra, Mandeep et al. "The Drug-Intoxication Epidemic and Solid-Organ Transplantation" NEJM DOI: 10.1056/ NEJMc1802706

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