washingtonpost.com: So many people are dying of drug overdoses that they’re easing the donated organ shortage
5/10/2016
Packets of heroin, a syringe and a spoon are displayed at the Drug Enforcement Agency in Portland, Maine. (Robert F. Bukaty/AP file)
America's opioid epidemic has had far-reaching and generally devastating consequences.
Now, the impact is being seen in organ donations.
Coinciding with a rise in drug-related deaths, the number of organ donors who died of drug overdoses has sharply increased in recent years — "a silver lining to what is absolutely a tragedy," Alexandra K. Glazier, president of the New England Organ Bank, recently told U.S. News & World Report.
Last year, 848 organ donors died of drug intoxication, according to Organ Procurement and Transplantation Network data. And while such organ donors have become more common over the decades, the recent numbers show a staggering jump.
In the previous five years, the share of organ donors who died of drug overdoses jumped by 50 percent.
Organ donations overall in 2015 increased by 5 percent from the previous year.
Now, one out of every 11 organ donors is a drug-overdose victim, according to government data.
"The increase in donors in the past year is pretty substantial and not really anticipated," said David Klassen, chief medical officer for the United Network for Organ Sharing. "A significant part of it can be explained by the drug overdoses as contributing to it, but not all of it. There's a lot of effort in the transplant community to increase donation and awareness of seeking every last donor and try to be as efficient as possible."
More people are dying of drug overdoses every year; since 2000, the rate of drug overdose deaths increased by 137 percent, according to the Centers for Disease Control and Prevention.
Much of the increase has been driven by prescription pain relievers and heroin.
In 2014, 47,055 people died of drug overdoses, according to the CDC. A record number died from prescription opioids and heroin.
"It's a horrible situation," Klassen said. "But the transplant donation is a way of potentially salvaging some good out of an awful situation."
The increase in organ transplants from drug-overdose victims may raise questions about safety. But organ transplants from drug users have been deemed acceptable for decades.
Such donors are labeled as "high-risk" because their behavioral history. According to U.S. Public Health Service guidelines, recipients have to give specific consent to transplants from high-risk donors.
[Her fiance gave her heroin. She overdosed. Does that make him a murderer?]
Organ donors are screened for HIV, Hepatitis B and Hepatitis C, and high-risk donors receive additional scrutiny, Klassen said.
"High risk is a relative thing," he said. "The reality is the risk of disease transmission from someone who is screened through that process is relatively low."
Still, it's impossible to eliminate the risk of disease transmission completely, even from non-high-risk donors, Klassen said.
In 2007, four patients in Chicago received organs from a donor who unknowingly had HIV, the first such case in 20 years. By 2011, Johns Hopkins researchers published a studythat found many transplant surgeons "overreacted" to that case and used fewer organs from high-risk donors.
"These organs help people and the risk of contracting an infectious disease from them is very small compared with other risks in transplantation,” the study's lead author, Dorry L. Segev, said at the time. “There is ample evidence that many patients are better off receiving organs from high-risk donors than waiting for a different organ, but that’s not what’s happening in many transplant centers.”
Most organ donors die of stroke, blunt injury and cardiovascular problems, according to government data.
"Truthfully, people who are dying of drug overdoses are young and tend to be otherwise healthy," Klassen said. "In many ways, they are ... potentially excellent donors, from an organ quality standpoint."
Long-term drug use can impact cardiac function or the kidneys, and "those medical factors are assessed very carefully," he added.
More than 121,000 people in the United States are on the waiting list to receive an organ transplant. The majority of those on the list are awaiting kidney transplants, for whom dialysis can be a viable alternative to a transplant.
[‘He was about to die on us': Heart transplant saves infant’s life]
But that's not the case for the 15 percent of transplant candidates waiting for a heart or liver, "where your alternative is potentially dying," Klassen said."
If you pass by an organ offer, you don't know when the next one might come," he said.