Hearts from opioid overdose donors safe for transplants

Heart transplant recipients implanted with hearts from donors who died from illicit drug overdoses have equally good outcomes as those whose hearts come from donors who died from other causes. The finding gives doctors greater confidence in the safety of using hearts from overdose donors, according to Max Xie, a masters student at the school of population and public health at the University of British Columbia. He presented results of his study on the topic at a poster session at the annual (virtual) conference of the Canadian Cardiovascular Society. “Doctors already had an inkling that these organs would be healthy and good for recipients. But only after using them for a number of years do we have enough data to look at survival outcomes,” he said. A large study in the U.S. had previously demonstrated transplant recipient outcomes were good, “but we wanted to see if that was true in Canada. British Columbia has had one of the highest rates of overdose deaths compared to the other provinces since 2017,” he said. Read: The story behind the new miniseries 'Dopesick,': an opioid crisis story that needed 'to be told' It’s an important issue to consider because one in every three donor hearts came from overdose death donors as recently as 2019 in B.C. That number may have increased more recently because deaths from illicit drug overdoses have increased drastically across Canada as a result of the COVID-19 pandemic. In 2020, B.C. saw 1,746 overdose deaths, a whopping 117% increase from 2016. The increased circulation of illicit fentanyl has been a driving force in the increased number of donors who died from drug overdose, Xie said. The study was done by analyzing data pertaining to heart transplantations in B.C. from January 2013 to December 2019 from donors ranging in age from 12 to 70 years. Data were extracted from the B.C. Transplant Patient Records and Outcome Management Information System database. Only first-time heart transplant recipients were included. A total of 115 heart transplants were identified where the overdose status of the donor was known; five were excluded from analysis because they were either part of a multiple transplant or the surgeries were for non-first time heart transplants. A total of 70 patients (median age of 56 years, 34.3% female) received hearts from non-overdose donors and 40 (median age of 58.5 years, 25% female) from overdose donors. A greater proportion of overdose death donors who donated a heart were younger than 40 years of age (87.5%) compared to non-overdose donors (71.4%). About the same percentage of donor hearts came from women in both groups, about 30%. A larger, but non-statistically significant, percentage of non-overdose hearts came from donors who had a history of hypertension (11.4%) and diabetes (2.9%) than those from the overdose death hearts, 5.0% and zero respectively. Other factors such as HLA mismatch, BMI and race were similar. After three years, survival from overdose-death heart transplantation was high at about 87%, Xie said. This was not different from the non-overdose-death transplantation cohort—even after accounting for differences in donor and recipient factors. He noted that hearts from overdose-death donors were more likely to be from younger adults with few comorbidities. The findings aren’t that surprising to people in the field, but it’s important to have data on it, said Dr. Marc Ruel, a cardiac surgeon and professor of surgery at the University of Ottawa Heart Institute. He was not part of the study. At the same time, people who die from these overdoses have higher rates of other comorbidities that could be of concern, such as infection with hepatitis-C (HCV) that are considered before a heart is used. But even HCV infection is less of a contraindication than it once was because of the arrival of direct-acting antivirals (DAAs) which offers a low-risk cure. Hearts from other donors tend to be from an older cohort who are more likely to have had comorbidities such as hypertension and diabetes. “The bottom line is this study formalizes what we suspected about hearts from overdose deaths. We don’t turn down a heart because it’s from an opioid overdose,” he said. Using these hearts helps make good out of the otherwise tragic circumstances of overdose deaths. “It’s a way you can continue the life of someone who died from an overdose,” Dr. Ruel said.

Hearts from opioid overdose donors safe for transplants

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