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The opioid epidemic’s impact on organ transplants

Surgeons perform a transplant. Lewis Teperman, MD, discusses how opioid overdose deaths have increased organ transplants with healthier organs.

Opioid overdose deaths were a catalyst to a record 36,500-plus organ transplants in the US last year. Are these organs safe?

The opioid epidemic has devastated families and communities for far too long. The National Institute on Drug Abuse estimates that about 130 people die each day from overdosing on these prescription medications.

While the crisis has wreaked tragedy on individuals, families and communities, there has been a population who has benefited — people needing organ transplants.

According to the United Network for Organ Sharing, a record 36,500 organ transplants were performed in the US last year, with 10,721 receiving one or more organs from deceased donors. The most striking statistic is that 13 percent of the nation’s organ donors now come from opioid overdose deaths.

The real deal

A major part of the issue is that young people who are overdosing are either transported to Emergency Departments or are administered naloxone on site. The opioid antidote reverses the effects of the overdose by binding the receptors in the brain to block the opioid.

Naloxone may save a life now, but it won’t deal with the ensuing problem — the unintended withdrawal that oftentimes leads individuals to take more opioids with the old dosage still in their system. It becomes too much. The narcotics stop their ability to breath and they die.

Some health care organizations, like Northwell Health, have worked with local municipalities to hold patients overdosing in the ED. But addiction is challenging and the deaths continue to mount.

Are organs from opioid overdose deaths contaminated?

Some transplant centers say they can’t take organs from overdose deaths because they are tainted by drugs. That’s partially true. These organs can potentially have diseases like hepatitis C. However, they are also the healthiest organs you will ever find, after you treat and cure the Hepatitis C.

Here’s why:

Opioids are killing younger people. Most are in their 20s, 30s even 40s and are very young compared to the typical organ donor in their 70s and 80s. These organs are younger and will last longer. An 80-year-old organ is still lifesaving, but the younger organs have a longer shelf life after we account for, treat and cure potential hepatitis.

The advent of direct-acting antiviral medications makes this possible and has proven to cure Hep C 99-plus percent of the time in 12 weeks. Where else can you find 99 percent accuracy?

Northwell's Transplant Services tells patients who can get a heart or kidney that the available organ is from a person who overdosed, and ensure them that hepatitis C will be cleared in three months if it shows. They will no longer will need life-saving dialysis or to continue to wait for a heart that may never come.

For 100 kidney transplants we performed in 2018, 60 came from deceased donors, half of those included organs that had Hep C. Of the 17 heart transplants completed, seven donors had the disease.

All cases were cleared of hepatitis.

A long way to go

The opioid epidemic won’t end, but is sure to fade over the next five years thanks to reduced prescriptions and more education. Surgeons don’t need to prescribe 60 pills after most procedures. Three typically suffices. And as we better understand why people are taking the drugs, we will see progress.

What’s more glaring is that despite the increase in organ donors from opioid deaths, the donor shortage continues. Last year’s 36,500-plus record pales in comparison to the 120,000 people who are on waiting lists. The need overwhelmingly dwarfs supply.

New York continues to have the lowest amount of registered donors. Residents can sign up at the DMV when applying for licenses or registrations but what of  the high population of those living in New York City who don’t drive? We need an easy way for those individuals to register. Another challenge resides in the state’s diverse communities who may feel strongly against donating and in the undocumented immigrants also don’t contribute in fear of incrimination.

We need to rethink the current registration system in order to increase the number of registered donors.

Lewis Teperman, MD, is Northwell Health’s vice chair of organ transplant surgery and director of organ transplantation. He is an expert in living donor liver transplantation, immunosuppression and organ preservation and has worked extensively in post-transplant treatment and prevention of hepatitis B and C. Dr. Teperman joined Northwell in 2016 after serving as vice chair of surgery at NYU Langone Medical Center, having founded and built the hospital’s Organ Transplant Center.