Effect of Donor Death by Drug Intoxication Combined with Chronic Drug Abuse on Lung Transplantation: A Single Center Study

Abstract

In the field of lung transplantation, there is a high wait list mortality. Broader use of extended criteria donors would provide additional organs for transplantation. An increasing number of organ donors are dying from drug overdose. These donors are often considered "high risk" because of their exposure to infectious diseases such as HIV and Hepatitis B and C. However, these organ donors are often younger and healthier than those that die from stroke or cardiac arrest. Successful use of lung donors who have a history of drug abuse may serve to provide additional organs for those patients on the wait list. This study reviews the results of lung grafts transplanted from donors with a history of drug abuse. This study is a retrospective analysis of 266 lung transplants done at a single center from 2014 to 2018. Extracted data included both donor and recipient characteristics, as well as clinical transplant outcomes. Donor history of illicit drug use was taken from the medical/social history derived by the onsite transplant coordinator. This history included both a review of the medical record, as well as an interview with family and friends of the donor. Clinical outcomes for this study included early and 1-year survival, need for ECMO, post-transplant ventilator time, hospital length of stay and 90-day readmission rates. Donors in this cohort died primarily from trauma (49%), stroke (21%), and anoxic brain injury (∼30%). Specifically, there were 37 donors who died from a drug overdose (15%). Drug use among all donors (lifetime) included use of THC (37%), cocaine (14%), amphetamines (15%), and opioids (18%). Additionally, a large percentage of donors had a history of active alcohol abuse (22%). Comparing patients who received a lung graft from a donor who died of drug overdose to all other patients, there was no difference in early death (p=0.69), survival at 1-year (p=0.21), need for perioperative ECMO (p=0.31), and hours post op on the ventilator (p=0.13). The drug overdose donor group had a shorter length of hospital stay (21 vs 25 days, p=0.06). These results demonstrate that drug use and abuse among lung donors is common. Donor lung grafts taken from a patient who dies of a drug overdose have similar outcomes compared to all other donors. More aggressive use of these donors may provide additional organs for transplantation.