Impact of Intoxicated Donors on Recipient Survival in Cardiac Transplantation: A Systematic Review and Meta-Analysis

Heart transplantation remains the main treatment for end-stage heart failure. The opioid crisis has increased donor availability, including organs from intoxicated individuals, but the impact on outcomes is uncertain.

Following PRISMA 2020, we searched MEDLINE, Embase, and Web of Science for studies on adult heart transplant recipients with donors exposed to substances like cocaine, heroin, marijuana, tobacco, or opioids. Eligible studies met PICOS criteria, and meta-analyses used a random-effects model.

Twelve retrospective cohorts were included, totaling 189 935 recipients, 33 393 of whom received organs from intoxicated donors. The most reported substances were cocaine, alcohol, and tobacco. No significant differences were found in 5-year survival (HR = 1.05; CI = 0.94-1.17), 10-year survival (HR = 0.94; CI = 0.88-1.00), or survival with overdose-related donors (HR = 0.96; CI = 0.84-1.09). Rates of allograft rejection (HR = 0.99; CI = 0.21-0.88) and cardiac allograft vasculopathy (HR = 1.02; CI = 0.95-1.11) were also similar. Subgroup and sensitivity analyses confirmed result consistency.

Organs from intoxicated donors do not compromise long-term outcomes and may help address donor shortages.