Changing demographics of heart donors: The impact of donor drug intoxication on posttransplant survival

Ising, Mickey S.; Gallo, Michele; Whited, William M.; Slaughter, Mark S.; Trivedi, Jaimin R.

doi:10.1111/ajt.14726

Cited by 13 publications

(15 citation statements)

References 21 publications

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“…Neither of these studies was able to differentiate from opioid and nonopioid causes of death, though based on the US national statistics above, the majority of cases will involve opioids alone (prescription or illicit) or often in combination with other drugs. Other reports dealing separately with hearts and lungs have also recently shown no adverse effects on survival . Thus, heart and lung donors from drug overdose patients should be considered for transplantation.…”

Section: Cardiothoracic Transplantation Outcomes With Opioidsmentioning

confidence: 97%

Effects of drug abuse, smoking and alcohol on donor hearts and lungs

et al. 2019

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Potential heart and lung donors with a history of illicit drugs and/or smoking and alcohol are frequently offered, though there is no clear guidance on when it is safe to use these organs. A review of the literature on effects of drugs, alcohol and smoking on donor outcomes, and the effects of these on the intact heart and lung was undertaken. There has been a marked increase in deaths from opioid abuse in many developed countries, though recent evidence suggests that outcomes after cardiothoracic transplantation are equivalent to nonopioid donor causes of death. For donor smoking, there is an increased risk with lung transplantation; however, that risk is less when compared to further waiting on the transplant list for a nonsmoking alternative. Heavy alcohol consumption does not adversely affect heart transplantation, and there is no clear evidence of adverse outcomes after lung transplantation. There are no overall effects of cannabis or cocaine on survival after heart or lung transplantation. In all these cases, careful donor assessment can establish if a particular organ can be used. In most cases, use of drugs requires careful assessment, but is not in of itself a contraindication to cardiothoracic transplantation.

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Section: Cardiothoracic Transplantation Outcomes With Opioidsmentioning

confidence: 97%

Effects of drug abuse, smoking and alcohol on donor hearts and lungs

et al. 2019

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“…Recent studies have looked at the UNOS cause of death field and have found that drug intoxication donor cause of death is not associated with adverse post-transplant outcomes. 10 , 13 …”

Section: Discussionmentioning

confidence: 99%

Intoxicated Donors and Heart Transplant Outcomes: Long-Term Safety

Baran

Lansinger

Long

et al. 2021

Circ: Heart Failure

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Background: The opioid crisis has led to an increase in available donor hearts, although questions remain about the long-term outcomes associated with the use of these organs. Prior studies have relied on historical information without examining the toxicology results at the time of organ offer. The objectives of this study were to examine the long-term survival of heart transplants in the recent era, stratified by results of toxicological testing at the time of organ offer as well as comparing the toxicology at the time of donation with variables based on reported history. Methods: The United Network for Organ Sharing database was requested as well as the donor toxicology field. Between 2007 and 2017, 23 748 adult heart transplants were performed. United Network for Organ Sharing historical variables formed a United Network for Organ Sharing Toxicology Score and the measured toxicology results formed a Measured Toxicology Score. Survival was examined by the United Network for Organ Sharing Toxicology Score and Measured Toxicology Score, as well as Cox proportional hazards models incorporating a variety of risk factors. Results: The number and percent of donors with drug use has significantly increased over the study period ( P <0.0001). Cox proportional hazards modeling of survival including toxicological and historical data did not demonstrate differences in post-transplant mortality. Combinations of drugs identified by toxicology were not associated with differences in survival. Lower donor age and ischemic time were significantly positively associated with survival ( P <0.0001). Conclusions: Among donors accepted for transplantation, neither history nor toxicological evidence of drug use was associated with significant differences in survival. Increasing use of such donors may help alleviate the chronic donor shortage.

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“…10 Similarly, posttransplant survival of opioid-intoxicated donor hearts and lungs is similar to that from nonintoxicated donors. 11,12 Even when dealing with brain-dead donors after ingestion of toxic substances mainly metabolized by the liver as, for instance, ethylene glycol or brodifacoum, a rodenticide with a potent anticoagulant effect, good graft outcome and acceptable recipient survival have been reported in the literature. Liver biopsy, hemodialysis to accelerate toxic clearance, and verification of the absence of the toxic substance in blood samples are the suggested strategies to optimize results.…”

Section: Discussionmentioning

confidence: 99%