Impact of the Opioid Epidemic on Lung Transplantation: Donor, Recipient and Discard Characteristics

Phillips KG1, Ward AF1, Ranganath NK2, Malas J1, Lonze BE3, Moazami N1, Angel LF4, Kon ZN1. (New York, USA. Electronic address: neel.ranganath@nyulangone.org.

Ann Thorac Surg. 2019 Jul 16. pii: S0003-4975(19)31026-4 . doi: 10.1016/j.athoracsur.2019.05.065. [Epub ahead of print]

BACKGROUND:
The national opioid epidemic may have expanded the donor pool for lung transplantation, but concerns remain regarding infectious risks and allograft function. This study compared donor/recipient characteristics, outcomes, and reasons for organ discard between overdose death donors (ODD) and all other mechanism-of-death donors.

METHODS:
Data on adult lung transplants from 2000-2017 were provided by the Scientific Registry of Transplant Recipients. Pulmonary allografts used in multiple organ transplantations were excluded. Donor/recipient demographics, outcomes, and organ discard were analyzed with regards to ODD since 2010. Discard analysis was limited to donors who had at least one organ transplanted but their pulmonary allografts discarded.

RESULTS:
From 2010-2017, 7.3% (962/13,196) of lung transplantations were from ODD, over a 3-fold increase from the 2.1% (164/7,969) in 2000-2007. ODD were younger but more likely to have a history of smoking, hepatitis C, or an abnormal bronchoscopy finding. Overall survival was similar between ODD and non-ODD groups. ODD of discarded pulmonary allografts were younger and more likely to be hepatitis C positive, but were less likely to have a history of smoking than their non-ODD counterparts.

CONCLUSIONS:
Rates of ODD utilization in lung transplantation have increased in accordance with the opioid epidemic, but there remains a significant pool of ODD pulmonary allografts with favorable characteristics that are discarded. With no significant difference in survival between ODD and non-ODD recipients, further expansion of this donor pool may be appropriate and pulmonary allografts should not be discarded based solely on ODD status.

Copyright © 2019. Published by Elsevier Inc. KEYWORDS: lung transplantation; opioid PMID: 31323210 DOI: 10.1016/j.athoracsur.2019.05.065