If you needed a life-saving transplant, would it make a difference if you knew the vital organ came from a drug addict? For increasing numbers of patients who are on the organ donation waiting list in the US, it's a question they have to consider.
Due in large part to the ongoing opioid epidemic, drug overdoses are now the leading cause of accidental deaths in America—surpassing car accidents and gun violence. In 2015 alone, 50,000 Americans died from drug overdoses, and the epidemic shows no sign of abating. In New England, for instance, just four percent of organ donors had died of a drug overdose in 2010. By last year, that number had risen to 27 percent.
With roughly 119,000 Americans waiting for life-saving transplants at any given time—22 of whom die every day—doctors are often forced to consider the relative risks of accepting organs from overdose victims. And in many cases, it's not a difficult call to make: "The risks of not receiving a transplant are greater than the risks of receiving organs from a donor who used drugs," says Alexandra Glazier, president and CEO of the New England Organ Bank. "There may be some transmission of infectious diseases like hepatitis that are seen more commonly in drug users, but that risk pales in comparison to not receiving the transplant."
Given advances in testing and screening, doctors are also feeling more and more comfortable with donors who carry various risk factors, says Christine Durand, an infectious disease specialist and assistant professor of medicine at Johns Hopkins School of Medicine in Baltimore. There are a few reasons why that's the case: First, all organ donors are tested for HIV as well as Hepatitis B and C using antibody testing and nucleic acid testing, which can reveal an infection as soon as two days after someone has been exposed.
"The availability of that testing has increased the comfort level with donations from drug injectors," Durand says. Because people who inject drugs have higher rates of diseases like Hepatitis and HIV, people who have died of an overdose are categorized as increased infectious-risk donors—a category that also includes people who have been on dialysis or had a sexually transmitted disease in the past year.
Organ recipients, too, must first agree to receive a transplant from an increased infectious-risk donor, and the transplant team generally shares some details of the donor's death. "There is a very careful consent process," Durand says. After the transplant is complete, recipients are closely monitored and tested for six months to ensure that no diseases have been spread.
Still, that's not to say there aren't risks. Early testing can be imperfect, particularly with hepatitis C, and there have been cases of infection being spread. "It's possible to miss it," Durand says. "But we now have a cure for hepatitis C that is easy, safe, tolerable, and effective." She adds that about 40 percent of people waiting for liver transplants already have hepatitis C anyway. The Boomer generation, which has been highly affected by the disease, is reaching the age where hep C is causing liver failure, making them more willing to accept a donation from someone who has the disease.
There's a natural assumption that organs from young people in general are better suited for transplants. But "[That's] complicated," Glazier says. "On the one hand, organs from young donors are well functioning in general, but on the other, there could be complicating factors that impair function." In other words, it's important to make distinctions based on how frequently the victim used drugs, and their physical condition when they died. Victims who are stable and in recovery but have a past history of drug abuse would likely be considered, Durand says. But ultimately, it comes down to how comfortable the transplant team and the recipient are with the donation.
"We're in this to save lives," Glazier says. "We work with the population that we have."