Homeless in Vancouver: The organs of U.S. drug overdose victims are saving thousands of lives

The spiralling death rate from opioid overdoses across the United States appears to be dramatically increasing the supply of organs for transplant, as organ donations from victims of drug overdoses have skyrocketed.

According to NPR, in the state of New England the percentage of organs donated annually by overdose donors has increased more than sixfold in six years, with overdose donors accounting for four percent of donated organs in 2010, 19 percent in 2015, and 27 percent in 2016 (as of August 31).

In human terms, that works out to 790 organ donations from deceased drug users in the first eight months of 2016, compared with 341 in all of 2010.

Nationally the increase is lower but still dramatic. According to the NPR story quoted above, the percentage of all organs donated in the U.S. annually by overdose donors increased fourfold in six years, from four percent in 2010, to 12 percent over the first eight months of 2016.

U.S. organ donations in 2015 increased five percent over 2014, according to the Washington Post, which also cites government data showing that one out of every 11 organ donors in the United States is now a drug overdose victim.

When combing through the many U.S. media reports of this “silver lining” to the escalating opioid overdose crisis, it is not always clear what geographical level the various quoted numbers cover—whether a single hospital, a city, a state or the entire nation.

What is perfectly clear however, is that the ongoing tragedy of fatal drug overdose deaths is being seen as something of a godsend by the U.S. organ transplant system.

The quantity and quality of dead drug users

In Philadelphia—where the percentage of overdose donors increased from fve percent in 2010 to 17 percent in 2015—the Philadelphia Enquirer explained why overdose victims make good organ donors.

Drug overdose victims tend to be young adults and the young are more likely to be organ donors and young organ donors mean more and healthier organs available for transplant—even if they are drug users.

U.S. Health Service guidelines class drug users as high-risk organ donors but, unlike in Canada, in the United States organ transplants from drug users have been seen as acceptable for decades.

While high-risk organ donors receive extra scrutiny, all organ donors in the U.S. are screened for communicable diseases, including HIV, hepatitis B, and hepatitis C. Furthermore, in the U.S., would-be recipients of organ transplants from high-risk donors have to give their informed consent.

A New York Times report from October explains that doctors can potentially use many organs from one donor and cites an example from the New England Organ Bank, where the organs from 69 deceased drug users were used to saved the lives of 202 recipients.

No silver lining to opioid overdose deaths in Canada

The deadly effects of opioid drugs, such as heroin and its substantially more potent cousin fentanyl, do not stop at the U.S.-Canada border. So far, here in British Columbia, there have been 775 overdose deaths—with fentanyl a contributing factor in at least 374 of the cases.

However, the death toll from drug overdoses in Canada has not resulted in any reported bounty of organ donations for any of the thousands of Canadians waiting in line for transplants. In 2014 that line was some 4,500 people long.

Health Canada’s guidelines surrounding organ transplant protocols classify intravenous drug users—along with gay men, sex trade workers, convicts, and detainees—as increased-risk donors. Organs from these donors may only be used through a process known as ‘‘exceptional distribution’’, defined under Health Canada’s Safety of Human Cells, Tissues and Organs for Transplantation Regulations.

It’s not clear how often (if at all) Canadian drug overdose victims are used as organ donors.

Back in 2014 the Canadian Society of Transplantation released a paper titled “Guidance on the Use of Increased Infectious Risk Donors for Organ Transplantation”, which advocated the creation of a framework designed to increase the safe and ethical use of organs from increased-risk donors (IRDs), such as intravenous drug users.

The CST’s argument was basically that the benefits of using IRDs (increasing transplants and decreasing wait-list times and mortality) far outweighed the risks, which in any event existed with all donor groups. Proper testing of all organ donors—explained the paper—would promote safety better than trying to screen out risk by blocking potential donors on the basis of behaviours.

In every important regard, the CST was advocating that Canada copy the United States' approach to high risk organ donors, namely rigorous testing and informed recipient consent.

There is a suggestion that the Canadian government smiled on the CST’s initiative in that the paper drew on the guidance of both the U.S. Public Health Service (PHS) and Health Canada.

Certainly, the apparent success of the U.S. in turning the tragic deaths of so many opioid drug users into new life for even more transplant recipients will not have escaped the notice of Canadian health officials—governmental and otherwise.