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Chicago, June 6, 2019 – The confluence of two major health crises – the opioid epidemic and the shortage of organs – has led surgeons to consider transplanting organs deemed less "perfect" for the purpose of. expand the donor pool and save more lives, according to a study published online today in The annals of thoracic surgery, published by Elsevier.
"The opioid epidemic has increased the proportion of transplanted hearts from overdose donors," said Nader Moazami, MD, of NYU Langone Medical Center in New York, NY, USA. "One of the roles of the transplant community is to at least partially alleviate the tragedy of this exponentially growing problem by optimizing the use of organs derived from ODD."
Dr. Moazami and his colleagues evaluated trends in organ donation and transplantation among drug overdose deaths using data from the scientific registry of transplant recipients for the years 2000 to 2017. Of the 15,904 transplants isolated heart from adult donors during this period, opioid overdoses (10.8%). ) were the fourth most common cause of death, behind blunt injuries (30.5%), haemorrhages / attacks (22.1%) and gunshot wounds (18.3%). In 2017, overdoses were responsible for more than 20% of donor deaths in 11 states; while in 2000, the highest rate of states was 5.6% and 33 states had less than 1% of donor deaths attributed to overdoses. The researchers also identified a significant increase in the percentage of transplants using ODD cores: 1.1% in 2000; 6% in 2012; and 14.2% in 2017. The current rate of ODD used for heart transplantation is 16.9%, 14 times more than in 2000.
"The dramatic increase in the rate of use of the SDGs was striking and it has increased in line with the rate of overdose deaths," said Dr. Moazami. "The significant impact of the opioid epidemic on transplantation is one of the main reasons for the increase in the number of organ transplants in recent years. . "
In addition, the researchers found that donors who died from an opioid overdose were often under the age of 40 and had a higher rate of drug abuse. However, they also had lower rates of diabetes and hypertension. As a result, the researchers found that ODD hearts had "favorable donor quality" and provided excellent results, equivalent to all other donor death mechanisms (overdose).
"We do not believe that the overdose status alone is a valid reason to rule out an otherwise viable donor heart, and this study confirms that ODD bodies should not be rejected because of inappropriate bias" said Dr. Moazami. "In the absence of a significant difference in survival between ODD and non-ODD recipients, further expansion of this donor pool may be appropriate, with more hearts potentially being used for transplantation."
For other organs, the opioid epidemic has also increased the number of people who can be donated to the United States. In another study by Dr. Moazami and colleagues to be published in The Annals, ODD opioids provided 7% of transplanted lungs from 2010 to 2017, compared to 2% in 2000-2007. The general conclusions are also consistent with those of this recent study, suggesting that the ODD lungs pose no additional risk to the safety of transplant recipients.
Impact of the hepatitis C virus on organ transplantation
The recent increase in opioid use has not only resulted in opioid-related overdose deaths, but also an increase in the number of hepatitis C virus (HCV) cases attributable to the consumption of opioids. injecting drug use. In fact, the study showed that HCV is often the reason why organs are discarded and not used. But in the current era, advances in medicine and sophisticated testing have minimized the risks badociated with positive organ transplantation for hepatitis C, said Dr. Moazami. In addition, hepatitis C is now a curable disease. Therefore, if organ recipients are infected, antiviral drugs can be administered. It is therefore particularly important to strive to minimize organ rejections for HCV and to improve their effective use, according to the researchers. .
"Despite the public crisis recently created by the epidemic of overdose of opioids, the impact on organ transplantation and the unexpected consequences of the increase in the number of hearts Donors are noteworthy, "said Robert SD Higgins, MD, MSHA, chief surgeon at Johns Hopkins Hospital in Baltimore, president of STS and former president of the United Network for Organ Sharing (UNOS), which does not have a doctor. did not participate directly in this research. "Many of these donors have been badociated with diseases that were traditionally considered" high risk "by the public health services.This important study underscores the need for further research in this area to better define risk "and reward the expansion – the donor pool to save more lives".
According to UNOS, more than 36,500 transplants were performed in 2018 – more transplants than ever before. About 3,400 of them were heart transplants. While 2018 has been a record year, the need for organ donors remains enormous. On average, 18 patients died each day while waiting for a transplant in 2017.
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Notes to editors
The article titled "Impact of the opioid epidemic on heart transplantation: characteristics of donors and organ rejection", by KG Phillips, NK Ranganath, J. Malas , BE Lonze, CG Gidea, DE Smith, ZN Kon, A. Reyentovich and N. Moazami (https: /
Find complete medical information presented to patients by experts in cardiothoracic surgery on the STS patient website (ctsurgerypatients.org). For a copy of the Annals article, contact Jennifer Bagley at +1 312 202 5865 or at [email protected] "> [email protected].
About the Society of Thoracic Surgeons
Founded in 1964, the Society of Thoracic Surgeons is a non-profit organization representing more than 7,500 cardiothoracic surgeons, researchers and other health care professionals worldwide dedicated to ensuring the best possible outcomes for cardiac, pulmonary and cardiac surgeries. heart. esophagus, as well as other surgeries at the chest. The Society's mission is to enhance the ability of cardiothoracic surgeons to provide optimal patient care through education, research and advocacy.
The annals of thoracic surgery is the official journal of STS and the Southern Thoracic Surgical Association. It has an impact factor of 3,779. http: // www.
About Elsevier
Elsevier is a global information badysis company that helps scientists and clinicians find new answers, reshape human knowledge and deal with the most urgent human crises. For 140 years, we have been working in partnership with the world of research to manage and verify scientific knowledge. Today, we are committed to bringing this rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of Strategic Research Management, R & D Performance, Clinical Decision Support and Vocational Training; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes more than 2,500 digitized journals, including The lancet and Cell, 39,000 e-book titles and many iconic reference books, including Gray & # 39; s Anatomy. Elsevier is part of RELX Group, a global provider of information and badytics for professionals and business customers across all industries. http: // www.
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