The effect of the opioid epidemic on donation after cardiac death transplantation outcomes

Background The opioid abuse epidemic and the deaths of otherwise healthy individuals due to drug overdose in the United States has major implications for transplantation. The current extent and safety of utilization of liver and kidney grafts from donation after cardiac death (DCD) donors who died in the context of opioid overdose is unknown. Methods Using national data from 2006 to 2016, we estimated the cumulative incidence of graft failure for recipients of DCD grafts, comparing the risk amongst recipients of organs from donors who died of anoxic drug overdose and recipients of organs from donors who died of other causes. Results One hundred and seventy-nine (6.2%) of 2908 liver graft recipients and 944 (6.1%) of 15 520 kidney graft recipients received grafts from donors who died of anoxic drug overdose. Grafts from anoxic drug overdose donors were less frequently utilized compared to other DCD grafts (liver: 25.9% vs. 29.6%, 95% CI for difference, -6.7 to -0.7%; kidney: 81.0% vs. 84.7%; CI for difference, -7.3 to -0.1%). However, the risk of graft failure at 5-years was similar for recipients of anoxic drug overdose donor grafts and recipients of other grafts (liver risk difference: 1.8% [95% CI, -7.8 to 11.8%], kidney risk difference: -1.5% [95% CI, -5.4 to 3.1%]). Conclusions In the context of the current opioid epidemic, utilization of anoxic drug overdose DCD donor grafts does not increase the risk of graft failure and may help to address waitlist demands. MH and RHA contributed to this work equally as senior authors, Miguel A. Hernán, MD, DrPH, Roberto Hernandez-Alejandro, MD Disclaimers and conflict of interest: None Contact information for corresponding authors: Kerollos N. Wanis, Department of Surgery, Western University. London Health Sciences Centre, Rm. C8-114, London, Ontario, Canada, N6A 5A5. knwanis@g.harvard.edu Authorship KNW, AM, KD, MH, and RHA participated in the study conception and design. KNW, AM, and MH participated in the data analysis. KNW, MH, and RHA wrote the article. AM, KD, KT, and BA-J provided critical revisions of the manuscript for important intellectual content. SRTR disclaimer: The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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