Christine M. Durand, MD *; Mary G. Bowring, MPH *; Alvin G. Thomas, MSPH; Lauren M. Kucirka, MD, PhD; Allan B. Massie, PhD; Andrew Cameron, MD, PhD; Niraj M. Desai, MD; Mark Sulkowski, MD; Dorry L. Segev, MD, PhD
Disclaimer: The data reported here have been supplied by the Minneapolis Medical Research Foundation as the contractor for the SRTR. The interpretation and reporting of these data are the responsibility of the authors and should in no way be seen as an official policy of or interpretation by the SRTR, the United Network for Organ Sharing/OPTN, or the U.S. government.
Acknowledgment: The authors thank John W. Ward, MD; Deborah Holtzman, PhD; Scott Holmberg, MD, MPH; Jon E. Zibbell, PhD; and Michele K. Bohm, MPH, at the CDC for their advice and data support for the manuscript.
Grant Support: 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).
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.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Not applicable. Statistical code: Available from Ms. Bowring (e-mail, firstname.lastname@example.org). Data set: Publicly available for purchase at www.srtr.org.
Requests for Single Reprints: Christine M. Durand, MD, Department of Medicine, Johns Hopkins University School of Medicine, 725 North Wolfe Street, Suite 211, Baltimore, MD 21205; e-mail, email@example.com.
Current Author Addresses: Dr. Durand: Department of Medicine, Johns Hopkins University School of Medicine, 725 North Wolfe Street, Suite 211, Baltimore, MD 21205.
Ms. Bowring, Mr. Thomas, and Drs. Massie and Segev: Department of Surgery, Johns Hopkins University, 2000 East Monument Street, Baltimore, MD 21205.
Dr. Kucirka: Department of Surgery, Johns Hopkins University School of Medicine, 2215 East Pratt Street, Baltimore, MD 21231.
Dr. Cameron: Department of Medicine, Johns Hopkins University, 720 Rutland Avenue, Ross 765, Baltimore, MD 21205.
Dr. Desai: Department of Medicine, Johns Hopkins University, 720 Rutland Avenue, Ross 771, Baltimore, MD 21205.
Dr. Sulkowski: Johns Hopkins University School of Medicine, 1830 East Monument Street, Room 445, Baltimore, MD 21287.
Author Contributions: Conception and design: C.M. Durand, M.G. Bowring, A.G. Thomas, L.M. Kucirka, A.B. Massie, A. Cameron, N.M. Desai, M. Sulkowski, D.L. Segev.
Analysis and interpretation of the data: C.M. Durand, M.G. Bowring, A.G. Thomas, L.M. Kucirka, A.B. Massie, A. Cameron, M. Sulkowski, D.L. Segev.
Drafting of the article: C.M. Durand, M.G. Bowring, A.G. Thomas, L.M. Kucirka, A.B. Massie, M. Sulkowski.
Critical revision of the article for important intellectual content: C.M. Durand, M.G. Bowring, A.G. Thomas, L.M. Kucirka, A.B. Massie, A. Cameron, N.M. Desai, M. Sulkowski, D.L. Segev.
Final approval of the article: C.M. Durand, M.G. Bowring, A.G. Thomas, L.M. Kucirka, A.B. Massie, A. Cameron, N.M. Desai, M. Sulkowski, D.L. Segev.
Provision of study materials or patients: M.G. Bowring.
Statistical expertise: M.G. Bowring, A.G. Thomas, L.M. Kucirka, A.B. Massie, D.L. Segev.
Obtaining of funding: C.M. Durand.
Administrative, technical, or logistic support: M.G. Bowring, A.B. Massie, D.L. Segev.
Collection and assembly of data: M.G. Bowring, A.G. Thomas, L.M. Kucirka, A.B. Massie.
The epidemic of drug overdose deaths in the United States has led to an increase in organ donors.
To characterize donors who died of overdose and to analyze outcomes among transplant recipients.
Prospective observational cohort study.
Scientific Registry of Transplant Recipients, 1 January 2000 to 1 September 2017.
138 565 deceased donors; 337 934 transplant recipients at 297 transplant centers.
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).
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.
Inability to distinguish between opioid and nonopioid overdoses.
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.
National Institutes of Health.
Durand CM, Bowring MG, Thomas AG, Kucirka LM, Massie AB, Cameron A, et al. The Drug Overdose Epidemic and Deceased-Donor Transplantation in the United States: A National Registry Study. Ann Intern Med. ;168:702–711. doi: 10.7326/M17-2451
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Published: Ann Intern Med. 2018;168(10):702-711.
Published at www.annals.org on 17 April 2018
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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