Opioid Crisis Contributes to Increased Heart, Lung Transplants

Mandeep R. Mehra, MD

From 2000 to 2016, the growing US opioid crisis contributed to an increase in organ transplants from donors dying of drug intoxication.

Investigators at Brigham and Women’s Hospital, Boston, MA and University of Utah, Salt Lake City, found that patients who received transplants from donors who died of drug intoxication did as well as patients who received transplants from other donors. The team specifically looked at heart and lung transplants as these are especially sensitive to the restricted blood supply common in people who die of drug intoxication.

"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, executive director of the Center for Advanced Heart Disease and medical director of the Heart & Vascular Center at BWH.

Researchers found an approximately 11-fold increase in the proportion of organ donors who died of drug intoxication in the US. These donors increased from 59 (1.2%) in the year 2000 to 1029 (13.7%) in the year 2016 (P <.001). Most of the increase in US organ transplants over the last 5 years came from this shift.

In contrast, the European countries included in the study had no significant change in the proportion or numbers of donor who died from drug intoxication during the same years.

"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,” said Mehra. “We were surprised to find that this is a US issue and not at all seen in the European transplant experience."

The researchers compared 1-year survival rates for patients who received a heart or lung transplant from donors who died of drug intoxication with recipients who received a heart or lung from donors who died from blunt head injury.

After adjusting for baseline characteristics, they noted no significant differences between the groups (for heart transplantation: hazard ratio, 0.85; 95% CI, 0.71 to 1.02; P = 0.07; for lung transplantation: hazard ratio, 0.87; 95% CI, 0.72 to 1.06; P = 0.17).

Mehra raised the point that as the opioid crisis begins to be addressed, fewer organs will be available for transplants from donors who died due to opioid intoxication. He emphasized the need for other options to increase the availability of organs for transplants.

"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."

In recent years, one pathway that has increased the availability of organs has been using organs from HIV+ donors for HIV+ recipients. Until 2013, the US did not permit transplants from HIV+ donors, even to HIV+ recipients. Even research and testing of these transplants were prohibited.

Those restrictions ended when President Obama signed the HIV Organ Policy Equity (HOPE) Act into law in 2013. However, it wasn’t until 2016 that a medical team at Johns Hopkins Medicine in Baltimore, Maryland performed historic liver and kidney transplants from HIV+ donors.

This letter was published in the New England Journal of Medicine in May 2018.