Intoxicated Donors and Heart Transplant Outcomes: Long-Term Safety

Abstract

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.

Donor Utilization in the Recent Era: Effect of Sex, Drugs, and Increased Risk

“…Previous work has demonstrated that the use of donors with history of drug use or toxicology positive for ≥1 drugs is not associated with long-term differences in mortality. 11 , 12 …”

“…Previous work has conclusively shown that donor drug history does not impact the posttransplant survival, though that is among donors who are selected for transplant (which leads to significant bias). 11 , 12 …”

“…Recently, data utilizing the donor toxicology results and historical variables were published, showing that survival was similar regardless of drug use (historical or toxicological evidence). 12 However, this analysis could not comment on the donors who were not utilized for transplantation. Using the same UNOS data set, 12 the current analysis endeavors to examine donors in the recent period, looking at the correlates of donor acceptance for heart transplantation, as well as factors associated with nonuse including the impact of donor drug use and increased risk behaviors.…”

“… 12 However, this analysis could not comment on the donors who were not utilized for transplantation. Using the same UNOS data set, 12 the current analysis endeavors to examine donors in the recent period, looking at the correlates of donor acceptance for heart transplantation, as well as factors associated with nonuse including the impact of donor drug use and increased risk behaviors.…”

Expanding Selection Criteria to Repairable Diseased Hearts to Meet the Demand of Shortage of Donors in Heart Transplantation

“…Patients who have received other donor organs, for example, liver and kidney, have higher rates of death and graft failures [ 49 ]. A long-term study completed by Baran et al saw no significant difference in survival between recipients who received a donor heart with a history of drug abuse compared to those who do not [ 50 ]. A more lenient view of OODDs hearts will help further to expand the donor pool.…”