TY - JOUR
T1 - The drug overdose epidemic and deceased-Donor transplantation in the United States a national registry study
AU - Durand, Christine M.
AU - Bowring, Mary G.
AU - Thomas, Alvin G.
AU - Kucirka, Lauren M.
AU - Massie, Allan B.
AU - Cameron, Andrew
AU - Desai, Niraj M.
AU - Sulkowski, Mark
AU - Segev, Dorry L.
N1 - Funding Information:
Dr. Durand is supported by the Division of Intramural Research, National Cancer Institute (grant K23CA177321-01A1). Drs. Kucirka, Massie, Cameron, and Segev are supported by the National Institute of Diabetes and Digestive and Kidney Diseases (grants F30DK095545 [Dr. Kucirka], K23DK101677 [Dr. Massie], R01DK111966 [Dr. Cameron], and K24DK101828 and R01AI120938 [Dr. Segev]). Dr. Sulkowski is supported by the National Institute of Allergy and Infectious Diseases (grant K24DA034621).
Funding Information:
This work was supported in part by the Division of Intramural Research, National Cancer Institute (grant K23CA177321-01A1), National Institute of Allergy and Infectious Diseases (grant K24DA034621), and by the National Institute of Diabetes and Digestive and Kidney Diseases (grants K24DK101828, R01AI120938, F30DK095545, R01DK111966, R01AG042504, D01DK096008, and K23DK101677). The funding sources had no role in the design, conduct, or reporting of the study or the decision to publish the manuscript.
Funding Information:
Disclosures: Dr. Desai reports grants, personal fees, and nonfinancial support from Merck outside the submitted work. Dr. Sulkowski reports grants from AbbVie, Gilead, Merck, Janssen, and the National Institutes of Health and personal fees from AbbVie, Gilead, Merck, Janssen, and Trek outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms .do?msNum=M17-2451.
Funding Information:
Grant Support: Dr. Durand is supported by the Division of Intramural Research, National Cancer Institute (grant K23CA177321-01A1). Drs. Kucirka, Massie, Cameron, and Se-gev are supported by the National Institute of Diabetes and Digestive and Kidney Diseases (grants F30DK095545 [Dr. Kucirka], K23DK101677 [Dr. Massie], R01DK111966 [Dr. Cam-eron], and K24DK101828 and R01AI120938 [Dr. Segev]). Dr. Sulkowski is supported by the National Institute of Allergy and Infectious Diseases (grant K24DA034621).
Publisher Copyright:
© 2018 American College of Physicians.
PY - 2018/5/15
Y1 - 2018/5/15
N2 - Background: The epidemic of drug overdose deaths in the United States has led to an increase in organ donors. Objective: To characterize donors who died of overdose and to analyze outcomes among transplant recipients. Design: Prospective observational cohort study. Setting: Scientific Registry of Transplant Recipients, 1 January 2000 to 1 September 2017. Participants: 138 565 deceased donors; 337 934 transplant recipients at 297 transplant centers. Measurements: The primary exposure was donor mechanism of death (overdose-death donor [ODD], trauma-death donor [TDD], or medical-death donor [MDD]). Patient and graft survival and organ discard (organ recovered but not transplanted) were compared using propensity score–weighted standardized risk differences (sRDs). Results: A total of 7313 ODDs and 19 897 ODD transplants (10 347 kidneys, 5707 livers, 2471 hearts, and 1372 lungs) were identified. Overdose-death donors accounted for 1.1% of donors in 2000 and 13.4% in 2017. They were more likely to be white (85.1%), aged 21 to 40 years (66.3%), infected with hepatitis C virus (HCV) (18.3%), and increased–infectious risk donors (IRDs) (56.4%). Standardized 5-year patient survival was similar for ODD organ recipients compared with TDD organ recipients (sRDs ranged from 3.1% lower to 3.9% higher survival) and MDD organ recipients (sRDs ranged from 2.1% to 5.2% higher survival). Standardized 5-year graft survival was similar between ODD and TDD grafts (minimal difference for kidneys and lungs, marginally lower [sRD, 3.2%] for livers, and marginally higher [sRD, 1.9%] for hearts). Kidney discard was higher for ODDs than TDDs (sRD, 5.2%) or MDDs (sRD, 1.5%); standardization for HCV and IRD status attenuated this difference. Limitation: Inability to distinguish between opioid and nonopioid overdoses. Conclusion: In the United States, transplantation with ODD organs has increased dramatically, with noninferior outcomes in transplant recipients. Concerns about IRD behaviors and hepatitis C among donors lead to excess discard that should be minimized given the current organ shortage.
AB - Background: The epidemic of drug overdose deaths in the United States has led to an increase in organ donors. Objective: To characterize donors who died of overdose and to analyze outcomes among transplant recipients. Design: Prospective observational cohort study. Setting: Scientific Registry of Transplant Recipients, 1 January 2000 to 1 September 2017. Participants: 138 565 deceased donors; 337 934 transplant recipients at 297 transplant centers. Measurements: The primary exposure was donor mechanism of death (overdose-death donor [ODD], trauma-death donor [TDD], or medical-death donor [MDD]). Patient and graft survival and organ discard (organ recovered but not transplanted) were compared using propensity score–weighted standardized risk differences (sRDs). Results: A total of 7313 ODDs and 19 897 ODD transplants (10 347 kidneys, 5707 livers, 2471 hearts, and 1372 lungs) were identified. Overdose-death donors accounted for 1.1% of donors in 2000 and 13.4% in 2017. They were more likely to be white (85.1%), aged 21 to 40 years (66.3%), infected with hepatitis C virus (HCV) (18.3%), and increased–infectious risk donors (IRDs) (56.4%). Standardized 5-year patient survival was similar for ODD organ recipients compared with TDD organ recipients (sRDs ranged from 3.1% lower to 3.9% higher survival) and MDD organ recipients (sRDs ranged from 2.1% to 5.2% higher survival). Standardized 5-year graft survival was similar between ODD and TDD grafts (minimal difference for kidneys and lungs, marginally lower [sRD, 3.2%] for livers, and marginally higher [sRD, 1.9%] for hearts). Kidney discard was higher for ODDs than TDDs (sRD, 5.2%) or MDDs (sRD, 1.5%); standardization for HCV and IRD status attenuated this difference. Limitation: Inability to distinguish between opioid and nonopioid overdoses. Conclusion: In the United States, transplantation with ODD organs has increased dramatically, with noninferior outcomes in transplant recipients. Concerns about IRD behaviors and hepatitis C among donors lead to excess discard that should be minimized given the current organ shortage.
UR - http://www.scopus.com/inward/record.url?scp=85045911354&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85045911354&partnerID=8YFLogxK
U2 - 10.7326/M17-2451
DO - 10.7326/M17-2451
M3 - Article
C2 - 29710288
AN - SCOPUS:85045911354
SN - 0003-4819
VL - 168
SP - 702
EP - 711
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 10
ER -