Intoxicated Donors and Heart Transplant Outcomes: Long-Term Safety.

Area of Science:

• Cardiology
• Transplantation Medicine
• Toxicology

Background:

• The opioid crisis has increased the availability of donor hearts for transplantation.
• Concerns exist regarding the long-term outcomes of using organs from donors with a history of drug use.
• Previous studies lacked comprehensive analysis of toxicology results at the time of organ offer.

Purpose of the Study:

• To evaluate long-term survival rates of heart transplant recipients in the recent era.
• To stratify survival based on toxicology results at the time of organ offer.
• To compare donor toxicology findings with reported history and their impact on survival.

Main Methods:

• Utilized the United Network for Organ Sharing (UNOS) database and donor toxicology data (2007-2017).
• Performed 23,748 adult heart transplants.
• Developed UNOS Historical and Measured Toxicology Scores; analyzed survival using Cox proportional hazards models.

Main Results:

• Donors with a history of drug use significantly increased during the study period (P<0.0001).
• Neither historical nor toxicological evidence of drug use was associated with differences in post-transplant mortality.
• Lower donor age and shorter ischemic time were positively associated with survival (P<0.0001).

Conclusions:

• Heart transplant recipients did not show significant survival differences based on donor drug use history or toxicology.
• The utilization of donors with toxicology evidence of drug use may help mitigate the ongoing donor shortage.
• Further research into long-term outcomes is warranted but current data suggests these organs are viable options.