Drug overdose mortality decline and deceased donor transplantation in the United States

Between 2009 and 2019, drug overdose deaths were linked to 42% of the growth in deceased organ donors in the United States. Recent national data indicate a 27% decline in overdose mortality from 2023 to 2024, the most substantial reduction in decades. It is unclear whether this public health achievement was accompanied by unintended consequences on transplantation. Using data from the Organ Procurement and Transplantation Network, we analyzed trends in deceased donor kidney transplant (DD-KT) and deceased donor liver transplant (DD-LT) rates, as well as the active waitlist size, from January 2015 to December 2024. Overdose decedent donor transplant rates rose until mid-2023, when they comprised more than 1 in 5 DD-KTs and DD-LTs nationally. Thereafter, rates declined by 45.1% for DD-KTs and 37.3% for DD-LTs. We observed concurrent disruption in two long-standing national trends- the overall DD-KT rate, rising since 2015, plateaued and the active kidney transplant waitlist size, declining since 2015, expanded. These data indicate that the national overdose mortality decline coincided with a significant deceleration in kidney transplantation activity. As overdose prevention efforts continue, proactive adaptations in the transplant system are warranted to mitigate long-term impact on waitlist candidates.