Researchers at the University of Miami’s Miller School of Medicine have found that the increased availability of transplant organs over the past decade was mostly caused by the opioid crisis. The study was published in the journal Clinical Transplant.“The data suggests the increase in organ availability is not due to large scale systematic improvements in the procurement system,” said associate professor David Goldberg, M.D., a transplant hepatologist at the University of Miami’s Miller School of Medicine and co-author on the paper. “On the national level, it is almost exclusively a byproduct of this ongoing tragedy. These are families and donors who saved lives in a final act of generosity. These transplants are lifesaving and we should honor -never diminish or mislabel – the circumstances of any donor’s gift.”
While previous research probed the link between drug-related deaths and organ availability, these studies took cause of death codes at face value. In some cases, intravenous drug users were coded as having died from drug intoxication. Others were coded for asphyxiation or heart attack, despite their drug use. Goldberg and co-author Raymond Lynch, assistant professor at Emory University School of Medicine, thought it was important to probe beyond the codes and understand underlying causes.
“We felt that just looking at the mechanism was undercounting the role of the drug epidemic,” said Goldberg. “When we looked at those donors who died from another mechanism, they looked very similar to those coded for drug intoxication. We saw 20, 30, 40-year-olds who had a cardiovascular death and also happened to be using drugs.”
The study found there were 2,700 more deceased donors nationwide in 2018 than 2009. Using the same years for comparison, the number of drug-related deaths increased by 2,752. By contrast, the number of non-drug-related donations decreased, with a notable decline in deaths from stroke.
Drug-related donation increases were most pronounced in the Northeast, Southeast and Midwest, reflecting the crisis acuity in those regions. For some organ procurement organizations (OPOs), volume increased by more than a 100%. Still, those increases did not always mirror regional drug-related death rates, pointing to potential faults in local organ procurement systems.
The researchers were particularly concerned that undercounting drug deaths would create the false sense that donation increases were generated by increased OPO effectiveness. In some cases, that was true. The OPO in Nevada saw a 202.3% increase in donors, with only 41.4% coming from drug-related deaths.
Goldberg and Lynch feel the OPO community needs to better understand why Nevada and others are doing so well. They hope these results will inspire an honest review and ongoing conversation among OPOs to identify the most effective ways to increase transplant organ availability.
“Everyone should share best practices and help other organizations that have not seen the same increases, despite being in an area that has seen a similar impact from the opioid epidemic,” said Goldberg. “We can’t let the increase from opioid deaths be a detriment because it prevents broader scale improvements in the OPO community.”
