[ad_1]
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" in order to expand the pool of donors and save more lives, according to research published online in The annals of thoracic surgery, published by Elsevier.
"The opioid epidemic has increased the proportion of hearts
transplant recipients of overdose donors (ODD), "said Nader Moazami, MD,
of NYU Langone Medical Center in New York, NY, USA. "One of the roles of
the transplant community must at least partially mitigate the tragedy
of this problem growing exponentially by maximizing the use of
ODD bodies. "
Dr. Moazami and his colleagues evaluated trends in organ donation and
transplants among drug overdose deaths using data from the
Register of transplants for the years 2000 to 2017.
15,904 isolated heart transplants from adult donors during this period,
Overdoses of opioids (10.8%) were the fourth most common cause of
death, behind blunt injury (30.5%), hemorrhage / stroke (22.1%)
percent) and a gunshot wound (18.3 percent). In 2017, the overdoses represented
for more than 20% of donor deaths in 11 states; whereas in 2000,
the highest rate was 5.6% and 33 states had less than 1
percentage of donor deaths attributed to overdoses. The researchers also
identified a significant increase in the percentage of transplants
ODD hearts used: 1.1% in 2000; 6% in 2012; and 14.2
percent in 2017. The current rate of ODD used for the heart
the number of transplants is 16.9%, 14 times more than in 2000.
"The dramatic increase in the utilization rate of optical discs was striking,
and it has increased concordantly with the rate of overdose deaths,
said Dr. Moazami. "The significant impact of the opioid epidemic on the
transplantation is one of the main reasons an organ transplant
the numbers have increased in recent years. "
In addition, researchers found that donors who died from opioids
overdoses were often younger than 40 years and had higher rates of
substance abuse. However, they also had diabetes and
hypertension. As a result, researchers discovered that hearts in ODD had
"Favorable cardiac donor quality" and provided excellent results
equivalent to all other death mechanisms of the donor (not overdose).
"We do not believe that the overdose status alone is a valid reason for
reject an otherwise viable donor heart, and this study confirms that
ODD bodies should not be rejected because of inappropriate bias, "said Dr.
Moazami. "Without a significant difference in survival between ODD and
non-SDG beneficiaries, the extension of this donor pool can be
appropriate, with more hearts potentially used for transplantation. "
For other bodies, the opioid epidemic has also increased the number of
available for donation to the United States. In another study of Dr. Moazami and
published in The Annals, opioid ODD provided 7%
lungs grafted from 2010 to 2017, compared with 2% in
2000-2007. The general conclusions were also consistent with those of this recent study.
study, suggesting that the ODD lungs pose no additional safety risk for
transplants.
Impact of the hepatitis C virus on organ transplantation
The recent increase in opioid use has not only led to
opioid-related overdose deaths, but also increase in hepatitis C virus
(HCV) because of injection drug use. In fact, the study showed that HCV is
often the reason why organs are thrown away and not used. But in the
current era, advances in medicine and sophisticated testing have helped
minimize the risks badociated with transplanting an organ that is
positive hepatitis C, explained Dr. Moazami. In addition, hepatitis C is
now a curable disease, so if the organ recipients are infected,
an antiviral drug can be administered, which makes it particularly important
efforts are being made to minimize rejection of HCV positive organs and
to improve their use, according to the researchers.
"Despite the public crisis caused by the epidemic of overdose of opioids
recently created, the impact on organ transplantation and the
The increase in the number of donor hearts has unintended consequences.
remarkable, said Robert S. D. Higgins, MD, MSHA, chief surgeon of the
John Hopkins Hospital in Baltimore, President of STS and former
Chair of the Unified Organ Sharing Network (UNOS), which was not
directly involved in this research. "Many of these donors have been
badociated with diseases that have always been considered "high
risk "by the public health services. This important study highlights the
need additional research in this area to clarify the "risk"
as well as the reward of expanding 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 these
were heart transplants. Although 2018 was a record year, the
the need for organ donors remains enormous. On average, 18 patients died
every day waiting for a transplant in 2017.
Please make a donation today.
Did you enjoy this article? So, consider making a donation today to ensure that Eurasia Review can continue to provide similar content.
Source link
