Optimizing organ donations from overdose deaths may help address national organ shortage

Originally Published By 2 Minute Medicine®. Reused on MPR with permission.

1. U.S. transplants using organs from overdose-death donors (ODDs) has increased 24-fold from 2000 to 2016, and transplant outcomes from organs donated by ODDs have been noninferior to those donated by trauma-death donors (TDDs) and medical-death donors (MDDs).

2. Compared to TDD organs, ODD kidneys and livers were discarded at a greater rate.

Evidence Rating Level: 2 (Good)          

Study Rundown: In the last 15 years, U.S. deaths from overdose have almost tripled.  In 2015, 52 404 deaths were reported.  Concurrently, the U.S. has a serious shortage of organ donations.  In 2017, there were 10 281 donors but over 120 000 waitlisted patients.  Better knowledge regarding the use of ODD organs could help address the organ shortage as well as assist provider and patient decision-making.  The authors of this prospective study used national registry data to study transplant outcomes after receiving an ODD organ.  The study found that U.S. organ transplants using ODD organs have increased 24-fold from 2000 to 2016.  In comparison to organs donated by TDDs and MDDs, transplant outcomes from ODD organs were noninferior.  There was a higher organ discard rate from ODDs, which the authors attributed to concerns about hepatitis C virus (HCV) and the behaviors of increased-infectious risk donors (IRDs).  The authors suggest that the possible risks attributed to HCV and IRD should be carefully compared to the benefits of such organs for potential transplant recipients.  Furthermore, they recommended optimization of ODD organ donation, which could help address the organ shortage.

A strength of the study was that the authors calculated E-values to characterize possible unmeasured confounding necessary to explain away their findings.  The E-values calculated by the authors supported the strength of their findings.  A limitation of the study was that overdoses due to opioids or nonopioids could not be differentiated.

Click to read the study in Annals of Internal Medicine

Relevant Reading: The opioid crisis and its consequences

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In-Depth [prospective cohort]: The authors of this prospective observational cohort study used data from the Scientific Registry of Transplant Recipients (SRTR) to study 138 565 deceased donors and 337 934 adult transplant recipients (who received a deceased donor transplant between 1 January 2000 and 1 September 2017) from 297 transplant centers.  Researchers found that ODD transplants increased 24-fold from 2000 (n = 149) to 2016 (n = 3 533).  In comparison to TDD and MDD organ recipients, ODD organ recipients had a similar standardized 5-year patient survival.  Standardized survival differences ranged from 3.1% lower to 5.2% higher for ODD kidney recipients and ODD lung recipients, respectively.  Compared to TDD grafts, the standardized 5-year graft survival for ODD grafts had a standardized risk difference (sRD) of 0.2% for kidneys, -3.2% for livers, and 1.9% for hearts.  Compared to MDD grafts, the standardized 5-year graft survival for ODD grafts had a sRD of 4.9% for kidneys, -1.0% for livers, and 2.6% for hearts.  The standardized 5-year graft survival for lungs was similar for ODDs, TDDs, and MDDs.  Compared to TDD organs, ODD kidneys (sRD = 5.2%) and livers (sRD = 1.8%) were discarded at a greater rate.

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