Registry also compared outcomes for this increasing source of organs
Hearts from overdose-death donors represent a growing proportion of transplants and appear to do as well as organs from other sources, a retrospective study found.
Overdose-death donors have accounted for a rapidly growing proportion of cardiac allografts, with a 14-fold increase from about 1% in 2000 to now 16.9%, "consistent with the rising opioid epidemic," reported Nader Moazami, MD, of New York University Langone Health in New York City, and colleagues in The Annals of Thoracic Surgery.
Notably, in many states, overdose-death donors comprised over 25% of cardiac allograft donors in 2018, with a high of 50% in Delaware, they wrote.
While there have been concerns regarding allograft function and infectious risk, the researchers noted overall survival was the same between recipients of overdose-death and non-overdose-death donor organs (P=0.066).
Discard analysis of donors who had at least one organ transplanted but not the cardiac allograft showed overdose-death donor hearts (7.4% of all discards) were:
- Less likely to be discarded due to being in a diseased organ condition than those donors who died of other causes (28.2% vs 36.1%; P<0.001)
- More likely deemed higher risk by Public Health Services (63.3% vs 13.2%; P<0.001)
- More likely to be hepatitis C positive (30.8% vs 5.3%; P<0.001)
"Survival outcomes of recipients of hearts that come from donors that have died from opioid overdose are equivalent to ones that we have traditionally been using, and because of this we believe that there are more donors out there that can be utilized," Moazami told MedPage Today.
This investigation provides additional information demonstrating that these are good quality organs, agreed Mary Keebler, MD, of the University of Pittsburgh Medical Center, who was not involved in the study. "It adds on to prior literature showing that the outcome with organs from these higher risk donors are just as good as in our donor pool from lower risk donors. It also highlights really nicely just the number of potential donors that we could be using that we aren't using to get our patients transplanted," Keebler told MedPage Today.
"These are younger donors, their hearts are arguably better quality than some of the non-opioid related death donors that we are using. So I think that we as a field just need to strongly consider using these organs to help our patients, because there's really very little downside at this point," Keebler said.
Moazami's group evaluated 14,194 non-overdose-death donor and 1,710 overdose-death donor heart transplantations using data from the Scientific Registry of Transplant Recipients. The overdose-death donor cohort less frequently needed inotropic support at procurement (38.4% vs 44.8%), was more likely to be hepatitis C positive (1.3% vs 0.2%), was more often younger than age 40 (87.2% vs 70.1%), and had higher rates of substance abuse.
Cardiac allografts implanted as part of multi-organ transplantation and those from donors with undocumented mechanisms of death were excluded.
Limitations of the investigation included selection bias when assessing cardiac allograft quality and assessment of the broader population of discarded overdose-death hearts was not completed.
"Additionally, although mortality and graft survival were similar between overdose-death donor and non-overdose-death donor groups, long-term infectious implications of using these 'high-risk' organs remains to be thoroughly elucidated," the researchers highlighted.
There will likely be increased use of cardiac allografts from hepatitis C-positive donors, who are otherwise considered healthy, the investigators indicated.
"We have used those organs successfully because now we have treatment for hepatitis C. Even though we know that the recipient is going to develop a hepatitis C viremia, we know that we can treat them effectively and still use the heart," Moazami emphasized.
"Further research will likely strengthen the argument that current discard criteria for overdose-death donor organs is too stringent, and greater use of these organs may help mitigate the tragedy of the opioid overdose epidemic," the investigators concluded.
Keebler reported no disclosures.
The Annals of Thoracic Surgery
Source Reference: Phillips KG, et al "Impact of the opioid epidemic on heart transplantation: donor characteristics and organ discard" Ann Thorac Surg 2019; DOI: 10.1016/j.athoracsur.2019.03.076.
Read the original article on Medpage Today: Opioid Overdose Now Provides 1 in 6 Donor Hearts