There's a bleak silver lining to America's ongoing opioid epidemic: So many organ donors are dying from drug overdoses that sick people are now more likely to receive a lifesaving transplant than in years past.
According to data collected by United Network for Organ Sharing (UNOS), a nonprofit organization that regulates organ donations and oversees the national organ waitlist, 848 organs were made available by donors who died from overdoses last year, a 270 percent increase from 2006. According to the US Department Health and Human Services, an average of 22 Americans die every day while waiting for an organ transplant.
The trend in increased organ availability is even more pronounced in areas that have been hit particularly hard by opioid addiction. According to Life Connection of Ohio, a non-profit organ procurement organization serving western Ohio counties, 3 percent of their organ donors died from drug overdoses in 2013. By the following year, that number had jumped to 18 percent. Officials attributed the spike to soaring numbers of heroin overdoses in the region.
So many Americans are hooked on heroin and prescription painkillers like OxyContin and Vicodin that drug overdose is now the leading cause of accidental death in the United States. More than half a million Americans died from drug overdoses from 2000 to 2014, according to the Centers for Disease Control and Prevention (CDC), with the number of fatalities surging by 137 percent during those years. There were 47,055 lethal drug overdoses in the US in 2014, and nearly 65 percent of them involved heroin or pain meds.
"Dying from an overdose doesn't disqualify anyone from being an organ donor," David Klassen, the chief medical officer at UNOS, told VICE News.
HHS guidelines say donors should be categorized according to a set of behavioral criteria. Under those guidelines, a donor who regularly used drugs and/or died from an overdose is labeled "high risk."
He said organs from "high risk" donors are assessed on a case-by-case basis, and that some organs take a heavier beating than others from sustained drug abuse or overdose. Long-term users of heroin, MDMA, or PCP, for example, may have significant kidney damage. Heroin and steroids can also harm the liver, but Klassen said a history of drug abuse doesn't automatically disqualify a person from donating any organ.
The gap between supply and demand for donated organs has continued to widen since the early 2000s, and more people than ever are left stuck on a waitlist at the end of each year. In 2003, there were nearly 84,000 people waiting for a donated organ at the end of the year. By 2015, that number climbed to around 122,000 people.
The organ shortage mostly has to do with changes in the donor pool. Gretchen Reynolds, writing for the New York Times magazine in 2005, noted that the pool has changed drastically since the early days of transplants. From the 1960s to the 1980s, Reynolds wrote, most donors were people who had been involved in car accidents or died from other types of head trauma. Most were young, with no history of addiction, disease, imprisonment, tattoos, or "unsafe sexual behaviors."
By the 1990s, the donor landscape changed dramatically. "Seat-belt use was more common by then, and fewer Americans were dying of head injuries, depriving transplantation of its most reliable sources of pristine organs," Reynolds explained.
The biggest concern about transplanting an organ from someone who died from an overdose is transmission of diseases such as HIV or hepatitis, which are associated with intravenous drug use. Even though these individuals are labeled high risk, Klassen says, "the actual risk is quite low, but can never be completely risk-free."
According to research cited by HHS, the odds of a "high risk" organ carrying undetected HIV virus are 1 in 12,000. For Hepatitis C, the risk is greater, but still slim — a 1 in 1,000 chance.
HHS guidelines say that donors in the "high risk" category should be subject to regular evaluation. The same guidelines also say that a transplant doctor should tell a potential recipient if a donor died from a drug overdose.
Klassen said most patients will accept a "high risk" organ if their odds of dying while on the waiting list far outweighs their chances of contracting a disease. "You have to balance that risk versus the recipients' need," Klassen said.