Friday, October 7, 2016

Drug deaths and deceased organ donors

Traffic accidents are down, but drug deaths are up, not just in total numbers but among deceased organ donations. ("Hypoxia" has entered my vocabulary in the last year...)
The NY Times has a story:
As Drug Deaths Soar, a Silver Lining for Transplant Patients

"As more people die from overdoses than ever before, their organs — donated in advance by them or after the fact by their families — are saving lives of people who might otherwise die waiting for a transplant.
"So far this year, 69 people in New England who died from an overdose have donated their organs, according to the New England Organ Bank. They account for 27 percent of all donations in the region, up sharply from 2010, when eight donors, or 4 percent, were drug users.

Because doctors can use multiple organs from each person, these 69 deceased drug users saved the lives of 202 other people, according to the organ bank.

Nationwide, more than 790 deceased drug users have donated organs this year, accounting for about 12 percent of all donations. That is more than double the 340 drug users who donated in 2010, or about 4 percent of the total, the organ bank said.

“It’s an unexpected silver lining to what is otherwise a pretty horrendous situation,” said Alexandra K. Glazier, chief executive of the New England Organ Bank, which procures organs for transplant in the six New England states and Bermuda.

Drug users have long been considered high risk because they often carry diseases like H.I.V. or hepatitis C. But at a time of a severe organ shortage, the volume of organs available from overdose deaths has led transplant centers to try to use them instead of throwing them away. With rigorous screening, officials say, the risk of transplanting an infected organ is small. Moreover, they say, hepatitis C can be treated if not cured and H.I.V. made manageable. Either is usually preferable to death.

“We know now that the mortality rate of being on the waiting list for several years is higher than that of getting an organ with an infection that is treatable,” said Dr. Robert Veatch, a professor emeritus of medical ethics at Georgetown University, who has written extensively about organ transplants.
"Transplants were initially associated with deaths from car accidents, which is why organ donors are noted on driver’s licenses. But overdoses (47,000 in 2014) have surpassed car crashes (32,000 in 2014) as the leading cause of accidental death in the United States. The growing numbers of overdoses from synthetic opioids like fentanyl and carfentanil have only heightened the drug toll.

Drug users are now the fastest-growing category of donor. They rank fourth, behind donors who died of strokes, blunt injuries and cardiovascular problems.

But even as drug users are making a life-or-death difference for some recipients, the need for organs remains vast.

There are 120,000 people on the national wait list for transplants. While 85 people receive one every day, 22 others die every day before a match is found.

One advantage of drug users as donors is that they tend to be younger and healthier than other donors, said Dr. David Klassen, chief medical officer for the United Network for Organ Sharing, which administers the nation’s organ procurement network.
"Dying of an overdose, which usually occurs when oxygen cannot reach the brain, does not affect kidney function or other organs. The drugs and blood are flushed from the organs when they are removed from the body."

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