Are overdose deaths from the opioid crisis fueling a rise in organ donations?
The number of people waiting for a life-saving organ transplant has long exceeded the supply of donors, though the gap has narrowed as organ donations have risen over the past decade. But some researchers and transplant experts disagree about what is driving the increase — a critical piece of information if health regulators are going to succeed at meeting the demand for organs.
Researchers from the University of Miami’s Miller School of Medicine found that an increase in organ donations over the past decade was “mostly caused by the opioid crisis,” though the study has drawn criticism from organ transplant experts who say the researchers used overly broad terms to define drug-related deaths in search of a predetermined conclusion.
The study, which was published last month in Clinical Transplant, was co-authored by UM doctor and associate professor David Goldberg, who takes a critical view of organ procurement organizations, the 58 nonprofit groups across the country that are responsible for evaluating and recovering organs from deceased donors.
Goldberg, a transplant hepatologist who researches chronic liver disease and organ donation, said the data shows that the upward trend in organ availability was “not due to large scale systematic improvements in the procurement system” and was instead due to a surge in opioid-related deaths.
“On the national level, it is almost exclusively a byproduct of this ongoing tragedy,” Goldberg said. “These are families and donors who saved lives in a final act of generosity. These transplants are lifesaving and we should honor — never diminish or mislabel — the circumstances of any donor’s gift.”
Goldberg and other researchers used organ donor data collected by a federal government contractor, dividing donors into four groups. Organ procurement experts said they agree about counting the first two groups as drug-related deaths: donors where the manner of death was due to drug intoxication and donors who died by other means but with a history of intravenous drug use noted in the database.
The third group, which counted as “drug-related deaths” in the UM study, is where the disagreement comes in: donors who are not included in the other groups, but have a history of non-intravenous drug use noted in the data. The fourth group is donors with no drug use history noted in the data.
‘Drug use’ debate
Sean M. Fitzpatrick, the vice president of public affairs for New England Donor Services, an organ procurement organization, said the third group “could reasonably apply to people who used (or even tried once, given the interpretation of “ever”) marijuana, hallucinogens, etc., conceivably decades before, as a teen or young adult, with no recent recurrence and no involvement ever with opioids.”
“Given that donors occur commonly up to ages including their early 60s, there is great latitude in this category,” Fitzpatrick said.
The UM study, Fitzpatrick argued, “appears to be the result of a preconceived conclusion in search of data” that defined drug-related deaths “well beyond the bounds of reasonableness.”
“No serious donation or transplant considers, for instance, a 60-year-old organ donor who died of an aneurysm but who used marijuana in the 1970s as a “drug-related death,” he said. “The entire premise of the study relies on re-categorizing large numbers of non-drug-related deaths incorrectly as drug-related deaths.”
The number of deceased donors rose by 2,700 between 2009 and 2018, according to the UM study. In that time, the number of deaths contributing to that increase that were not “drug-related,” as categorized by the Goldberg study, decreased by 52. The number of drug-related deaths, meanwhile, increased by 2,752 — a 102% increase, the study found, concluding that “the increased numbers of donors is almost wholly attributable to the drug epidemic.”
The United Network for Organ Sharing, a nonprofit that manages the country’s organ transplant system under a federal government contract, said drug-related deaths actually account for about 40 percent of the increase in organ availability. Joel Newman, the group’s spokesman, said donors are grouped as intravenous or non-intravenous drug users to assess the risk of potentially transmissible blood-borne diseases like hepatitis or HIV.
“The categories as reflected in our data do not address questions of frequency or history as it relates to immediate cause of death,” he said.
In response to the criticism from organ procurement experts, Goldberg pointed to the demographics of donors who had a history of non-intravenous drug use. In the 2018 data, Goldberg said, those listed as death by drug overdose had an average age of 33, those that had died from another mechanism but had a history of intravenous drug use had an average age of 37, and those that had died from another mechanism but had a history of non-intravenous drug-use had an average age of 40.
“So I’d push back that these are people who could be very old in their 50s and 60s who used drugs many years ago,” Goldberg said.
Is transplant system working?
The greater debate at issue, Goldberg said, was the performance of organ procurement organizations. He said he has had several people close to him who needed transplants “wait longer than they needed to.”
“There’s no doubt that the organ supply does not meet the demand. That’s a fact,” Goldberg said. “The numbers clearly increased over the years, but to understand why they’ve increased, we need to understand what factors have led to increases.”
Goldberg’s study comes at a time of heightened scrutiny on organ procurement organizations. Earlier this week, the Centers for Medicare & Medicaid Services proposed a rule change to the way organ procurement organizations are “held accountable for their performance.”
The proposed rule, issued by the Health Resources and Services Administration, would expand the scope of reimbursable expenses for donors who require more financial support. CMS also proposed what it described as “much needed changes to hold [organ procurement organizations] accountable and incentivize them to actively collect donated organs and improve transplantation rates.”
The Association of Organ Procurement Organizations said it welcomed the rulemaking “as an opportunity to drive meaningful changes that will increase the availability of organs for transplant and save more lives.”
“An independent, verifiable metric for evaluating OPO performance can be an important tool, helping to identify potential opportunities for growth, in OPOs’ quest for continual improvement,” the group said.
According to the organization, 2018 was the eighth-consecutive record-setting year for organ transplants in the United States, with 10,721 deceased organ donors providing 32,857 organs for transplant.
This story was originally published December 19, 2019 at 6:00 AM.
