Drug crisis boosts supply of organ transplants

The spike America has seen in drug overdose deaths in recent years has provided an unexpected lifesaving benefit for others by increasing the number of desperately needed organ transplants.

So far this year, 12 percent of deceased organ donors in the U.S. died of drug intoxication, according to the United Network for Organ Sharing (UNOS)—791 out of a total of 6,557. That’s more than the number who died of gunshot wounds.

While the percentage of organ donations from people who died of drug overdoses has risen steadily over the past two decades, UNOS data shows it’s most notably increased in the past four years.

As reported in the New York Times last week, the organs of drug users who died of overdoses were either donated by them in advance or by family members after their deaths, and are being offered to people who might otherwise die waiting for a transplant.

“It’s an unexpected silver lining to what is otherwise a pretty horrendous situation,” Alexandra K. Glazier, chief executive of the New England Organ Bank, which procures organs for transplant in the six New England states and Bermuda, told the newspaper.

While drug users have long been viewed as “high risk” donors because they often carry infections like HIV and hepatitis C, that thinking has shifted in recent years. Amid a severe organ shortage, more and more transplant centers across the country are trying to use organs donated from overdose deaths rather than keep desperately ill patients waiting even longer. Experts argue that the risk of transplanting an infected organ is small, and even if hepatitis C or HIV were passed along, those conditions can be managed with medications and are usually a better outcome for recipients who otherwise may be facing imminent death.

“We know now that the mortality rate of being on the waiting list for several years is higher than that of getting an organ with an infection that is treatable,” Dr. Robert Veatch, a professor emeritus of medical ethics at Georgetown University, who has written extensively about organ transplants, told the Times.

Though it is rare, transmission of infection through organ donation does happen.  According to UNOS data, from 2006 to 2015, 249 of 174,388 people who received an organ transplant contracted a disease from their donors. Seventy-one of them died.

However, with more intense screening processes than ever before, a thoroughly informed consent process, and the ability to treat most infections, more centers are taking these high-risk donors.

While knowingly transplanting organs from people with HIV was illegal in the United States for decades, that law changed in 2013.

In a high profile case earlier this year, surgeons at Johns Hopkins Medical Center for the first time transplanted organs from an HIV-positive donor to HIV-positive recipients. The surgeries are part of a research project to determine if HIV-positive transplants really can help HIV-positive recipients. (Patients who don’t already have the AIDS virus would not be given organs from an HIV-positive donor.)

Nearly 120,000 people are on the national wait list for transplants, according to the Organ Procurement and Transplantation Network. Every 10 minutes, someone is added to that list and on average, 22 people die each day waiting for a transplant.

It’s not tracked how many of those waiting have HIV, but experts say the new approach could free up some space as HIV-positive patients take advantage of organs available only to them.

Similarly, while organs from drug donors are considered high risk, using them can help reduce time on the waiting list, as well.

Experts say recipients must be told if they are being offered an organ from a high-risk donor and they do not lose their place on the list if they decline. Often whether or not they consent depends on how sick they are.

Arthur L. Caplan, head of the division of medical ethics at New York University’s Langone Medical Center told the Times that “if you’re facing death and someone is throwing you a potential life preserver, the less interested you are in who made the life preserver and where it came from.”