As Arkansas and U.S. opioid drug-related deaths increase, so do organ donations

One of the unintended and morbid consequences of the rising number of opioid-related drug overdose deaths in Arkansas and across the U.S. is the recent turnaround in the nation’s waiting list of organ transplants.

The United Network for Organ Sharing (UNOS) reported in January that organ transplants performed in the U.S reached a new record high for the fourth consecutive year in 2016. For the year, 33,606 transplants were reported, an 8.5% increase over the 2015 total and an increase of 19.8% since 2012.

“Thousands more men, women and children are receiving a life-saving transplant opportunity each year,” said Dr. Stuart Sweet, president of the OPTN/UNOS Board of Directors. “We are deeply grateful to all who have chosen to help others through the life-saving act of organ donation. We are also very conscious that many more people are still anxiously awaiting a transplant, so we must continue to work with our partners in the donation and transplant community to meet the needs of those who continue to wait.”

And despite the increased number of life-saving transplants from donors dying from drug overdoses, nearly 20 people in the U.S. still die each day while waiting for a life-saving transplant of a solid organ, such as a heart, kidney, liver, lung, pancreas or intestines. Altogether, there are 116,626 on the national waiting list, with 75,526 as active candidates, or those eligible to be considered for organ offers at a given point in time.

The need is still so great that the UNOS Ethics Committee has led discussions on whether the organ donation community should lobby state and federal lawmakers to push a presumed consent or “opt out” model, meaning all citizens would be eligible for organ transplants unless they opt out before dying. The U.S. uses “donation model” consent for deceased organ recovery that prioritizes the rights of the individual or surrogate family decision-maker over the needs of society by requiring authorization or explicit consent prior to deceased organ and tissue recovery. In Arkansas, there are 272 people on the state’s waiting list as of Sept. 4. Of that total, 195 are waiting for kidneys, 43 for livers, and 34 for hearts, according to the OPTN database.

INCREASE IN DRUG DEATHS
UNOS, the federal Organ Procurement and Transplantation Network (OPTN) that manages the national organ transplant list, said the recent growth in overall transplants is largely driven by an increase in the number of deceased donors, part of a continuing a six-year trend of annual increases. Many of the deceased donors provide multiple organs for transplantation, UNOS noted, with nearly 82% (27,628) of the transplants involving organs from deceased donors. The remaining 18%, or 5,978, were performed with organs from living donors.

UNOS spokeswoman Anne Paschke told Talk Business & Politics there were 892 more deceased donors in 2016 than the previous year. Nearly half of those donors died from what is known as combined drug intoxication, which often involves a lethal mix of opioids and other illegal and prescription drugs.

“There were 415 more donors who died of drug intoxication in 2016 than in 2015, so that category accounted for almost 47% of the increase (of organ transplants) between 2015 and 2016,” Paschke said.

And already in 2017, the number of deaths from drug intoxication across the U.S. has topped 2015 levels, and is likely to eclipse last year’s total of 1,263, according to national data compiled by UNOS. To date, there have been 807 drug intoxication deaths in the U.S., which represent 13.4% of the 6,016 deceased donors that have provided multiple organs for transplantation.

ARKANSAS DONOR NUMBERS
There also has been a dramatic increase in the number of deceased donors in Arkansas who have died from lethal drug cocktails. From 2012-2016, 35 deceased donors died from drug overdoses, up 119% from only 16 in the prior five years, according to federal data provided UNOS/OPTN.

Little Rock-based Arkansas Regional Organ Recovery Agency (ARORA), one of the nation’s 58 federal-mandated organ procurement organizations, serves 64 of 75 counties in the state. Mid-America Transplant of St. Louis and Memphis-based Mid-South Transplant Foundation serve the 11 remaining counties in northeast Arkansas.

Overall, Arkansas had an all-time high of eight organ donors who died of drug overdoses in 2012, 2013 and 2016, the most of any year since UNOS began compiling national data in 2002. Overall, ARORA oversaw the recovery of organs and tissue from 78 deceased and 27 living donors in 2016. In 2017, that total number of deceased donors was already up to 45 donors through the first half of the year.

DISEASE TRANSMISSION CONCERNS
Still, there are some concerns from some in the healthcare field and the organ donor community about the ethics of getting an organ from someone who died from a drug overdose, mainly because the possible transmission of diseases, such as HIV or hepatitis, are associated with risky drug use.

According to UNOS, an increasing number of deceased donors in 2016 had medical characteristics or a medical history that, in prior years, may have been considered less often by clinicians. These include people who donated after circulatory death as opposed to brain death, as well as donors who died of drug intoxication or those identified as having some increased risk for blood-borne disease.

“While donation and transplant professionals always use their best medical judgment in evaluating donors and organ offers, over the last several years we’ve had success using organs from donors with certain criteria we may not have accepted in the past,” said Dr. David Klassen, UNOS’ chief medical officer. “Among our key goals as the OPTN, working with our members nationwide, is to ensure that as many organs as possible are accepted and used for the patients who will benefit from them the most, while maintaining high levels of patient safety.”

In an interview with Talk Business & Politics, UNOS Research Analyst Marissa Clark said if a deceased donor died of a drug overdose, it is up to the local OPO or transplant doctor to determine how much information is provided to the organ transplant recipient about the donor’s past drug use. That includes those donors with a history of IV drug use or those labeled by health officials with an “increased risk” of carrying an infectious disease such as hepatitis C or HIV, she said.

To highlight the conundrum in the organ donation community, a OPTN/UNOS committee met in Chicago this spring to discuss concerns some members had regarding donors who might not fall into the increased risk category but still were seen as potentially dangerous donors due to drug history.

OPIOID DEATHS BRING FINANCIAL GAINS
Many of nation’s organ procurement agencies, including ARORA, are seeing a financial windfall from the increase in organ and tissue donations. Unlike life-saving organ donors, OPO’s and tissue banks can pocket up to $130,000 per deceased donor by harvesting non-lifesaving body parts such as skin, bones, tendons, heart valves, veins and eyes.

In a blog post on the website of the Philadelphia-based Gift of Life Institute entitled “The Impact of Opioid Overdose on Donation,” staff nurse Patricia Mulvania advocates that donor professionals should educate health care providers to recruit family members of loved ones who have died from a drug overdose.

“Families of these victims are emotionally depleted by often years-long battles to help their loved ones overcome their addiction, only to find that the battle has culminated in their worst nightmare. All has been lost,” writes Mulvania, a registered nurse. “When talking with healthcare providers who feel drug addiction and overdoses render individuals’ incapable of offering the gift of life through donation, be sure staff have solid talking points that can help them convey the positive outcomes that can be achieved through donation.”

Over the past four years, the same period in which U.S. transplants from drug overdoses have nearly doubled, the Gift of Life Institute’s annual revenues jumped 29% from $52.7 million in fiscal 2012 to $68 million in fiscal year 2015, according to the nonprofit’s latest 990 tax filings with the Internal Revenue Service.
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Editor’s note: This is the final of three stories on the opioid issue as it relates to Arkansas. Link here for the first report, and link here for the second report.