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Transplant Docs Too Picky About Organs from Overdose Deaths?

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Medpage Today

Transplant Docs Too Picky About Organs from Overdose Deaths?

New evidence suggests these organs are perfectly OK

MedpageToday

Analyst: F. Perry Wilson, MD, MSCE

A side effect of the opioid epidemic is a surge of potential organ donors that died after overdose. In this 150-Second Analysis, F. Perry Wilson, MD, MSCE, examines a study that shows that organs from donors who overdosed are rejected more frequently than organs from other donors but that, importantly, the organs that do get transplanted fare just as well as organs from traditional donors.

Imagine you are a dialysis patient. Three days a week, you spend 4 hours in a chair hooked up to a dialysis machine. You’ve been on the transplant waitlist for 4 years. Finally, you get the call. There’s a kidney for you. But the donor died due to a drug overdose. Do you say yes?

This phone call is coming more and more frequently as the opioid epidemic continues to claim lives. But until now, we didn’t have enough data to inform an answer to the question. Now this paper appearing in the Annals of Internal Medicine suggests very strongly that if you (or your patient) gets that call, you should say yes.

Researchers used data from the Scientific Registry of Transplant Recipients which records data from every organ transplant in the U.S., including the donor’s cause of death.

The “ideal” donor — though ideal doesn’t feel like the right word here — is a young, healthy individual who suffered brain death due to trauma. As you can see from the chart, roughly 40% of donors met that criteria, while 55% died due to medical causes.

Over the 17 years examined in the study, just around 5% of donors had died from an overdose, but that number has skyrocketed recently.

In the year 2000, 1% of organ donors had died of overdose. Today, 13.4% of donors have died from an overdose. And in areas endemic for opioid abuse, that number is even higher – it’s around 35% in Massachusetts right now.

Once an organ donor is identified, organs are procured, but that’s not the end of the story. Some organs never find a willing recipient – these become “discards” and the data clearly shows, even after adjustment for multiple factors, that organs from those who died of drug overdoses are discarded more frequently than organs that come from trauma patients.

But is that evidence of smart practice, or just bias? Are these bad organs?

The authors argue that these organs are perfectly fine, based on the fact that the organs from donors after drug overdose do just as well as organs from individuals who died after trauma.

In other words, we may be discarding these organs inappropriately, and given the necessity to increase the organ pool (there are 120,000 individuals on organ wait lists and just over 10,000 donors in 2017), we should make efforts to increase transplantation rates among individuals who died of drug overdoses.

Now we need to be a bit careful here. Maybe the overdose organs that get transplanted do so well because physicians and patients are being so picky about them. It’s reasonable to think that individuals may only be willing to accept an organ from a donor who overdosed if it is essentially perfect in every other way.

But data like this helps us make better choices – it moves us from conjecture and gut instinct to hard evidence, and in this case the evidence is leading us to give these organs a second look.

F. Perry Wilson, MD, MSCE, is an assistant professor of medicine at the Yale School of Medicine. He is a MedPage Today reviewer, and in addition to his video analyses, he authors a blog, The Methods Man. You can follow @methodsmanmd on Twitter.

2018-04-16T17:00:00-0400
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At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.

Medpage Today

Transplant Docs Too Picky About Organs from Overdose Deaths?

New evidence suggests these organs are perfectly OK

MedpageToday

Analyst: F. Perry Wilson, MD, MSCE

A side effect of the opioid epidemic is a surge of potential organ donors that died after overdose. In this 150-Second Analysis, F. Perry Wilson, MD, MSCE, examines a study that shows that organs from donors who overdosed are rejected more frequently than organs from other donors but that, importantly, the organs that do get transplanted fare just as well as organs from traditional donors.

Imagine you are a dialysis patient. Three days a week, you spend 4 hours in a chair hooked up to a dialysis machine. You've been on the transplant waitlist for 4 years. Finally, you get the call. There's a kidney for you. But the donor died due to a drug overdose. Do you say yes?

This phone call is coming more and more frequently as the opioid epidemic continues to claim lives. But until now, we didn't have enough data to inform an answer to the question. Now this paper appearing in the Annals of Internal Medicine suggests very strongly that if you (or your patient) gets that call, you should say yes.

Researchers used data from the Scientific Registry of Transplant Recipients which records data from every organ transplant in the U.S., including the donor's cause of death.

The "ideal" donor -- though ideal doesn't feel like the right word here -- is a young, healthy individual who suffered brain death due to trauma. As you can see from the chart, roughly 40% of donors met that criteria, while 55% died due to medical causes.

Over the 17 years examined in the study, just around 5% of donors had died from an overdose, but that number has skyrocketed recently.

In the year 2000, 1% of organ donors had died of overdose. Today, 13.4% of donors have died from an overdose. And in areas endemic for opioid abuse, that number is even higher – it's around 35% in Massachusetts right now.

Once an organ donor is identified, organs are procured, but that's not the end of the story. Some organs never find a willing recipient – these become "discards" and the data clearly shows, even after adjustment for multiple factors, that organs from those who died of drug overdoses are discarded more frequently than organs that come from trauma patients.

But is that evidence of smart practice, or just bias? Are these bad organs?

The authors argue that these organs are perfectly fine, based on the fact that the organs from donors after drug overdose do just as well as organs from individuals who died after trauma.

In other words, we may be discarding these organs inappropriately, and given the necessity to increase the organ pool (there are 120,000 individuals on organ wait lists and just over 10,000 donors in 2017), we should make efforts to increase transplantation rates among individuals who died of drug overdoses.

Now we need to be a bit careful here. Maybe the overdose organs that get transplanted do so well because physicians and patients are being so picky about them. It's reasonable to think that individuals may only be willing to accept an organ from a donor who overdosed if it is essentially perfect in every other way.

But data like this helps us make better choices – it moves us from conjecture and gut instinct to hard evidence, and in this case the evidence is leading us to give these organs a second look.

F. Perry Wilson, MD, MSCE, is an assistant professor of medicine at the Yale School of Medicine. He is a MedPage Today reviewer, and in addition to his video analyses, he authors a blog, The Methods Man. You can follow @methodsmanmd on Twitter.

2018-04-16T17:00:00-0400
Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.



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