Are Lung Allografts From Drug Overdose Deaths Safe to Use for Transplantation? A Nationwide Analysis

The increase in drug overdose deaths (DODs) has resulted in an increased pool of potential organ donors. We assessed the pattern of use of DOD donors and describe outcomes of lung transplant recipients who received allografts from DOD donors.

The United Network for Organ Sharing registry was used to identify all adult (aged ≥18 years) isolated lung transplant recipients between January 2010 and June 2022. Recipient allografts from DOD donors were compared with allografts from donors who died of other causes. Long-term survival was assessed with unadjusted Kaplan-Meier curves, the log-rank test, and risk-adjusted multivariable Cox proportional hazards models.

We identified 28,495 adult lung recipients who met inclusion criteria, and 12.1% (n = 3437) received allografts from DOD donors. The yearly volume of DOD recipients nationwide increased from 67 in 2010 to 531 in 2022 (Mann-Kendall trend test, P < .001). Survival did not significantly differ between DOD and non-DOD recipients at 30 days (hazard ratio, 0.96; 95% CI, 0.76-1.23), 1 year (hazard ratio, 1.04; 95% CI, 0.92-1.17), or 3 years (hazard ratio, 1.04; 95% CI, 0.96-1.12). DOD recipients had longer average length of stay (27.7 vs 27.4 days), were less likely to have no postoperative ventilatory support (1.6% vs 2.9%), and a greater proportion were intubated at 72 hours (25.4% vs 21.6%).

Use of DOD lungs in lung transplantation has increased in the last decade. Long-term recipient outcomes were similar compared with all other donors. These results support the safety of using DOD lungs.