Pubdate: Thu, 06 Oct 2016
Source: New York Times (NY)
Copyright: 2016 The New York Times Company
Author: Katharine Q. Seelye


BOSTON - The surge in deaths from drug overdoses has become an
unexpected lifeline for people waiting for organ transplants, turning
tragedy for some into salvation for others.

As more people die from overdoses than ever before, their organs -
donated in advance by them or after the fact by their families - are
saving lives of people who might otherwise die waiting for a transplant.

When Dave and Roxanne Maleham got the call in June that they had long
dreaded - that their son, Matt, 38, was on life support after
overdosing on heroin and fentanyl - they talked about donating his

"We were trying to think if we could draw any good out of this
tragedy," said Mr. Maleham, pastor at Union Congregational Church in
Union, N.H.

Matt, as it turned out, had already registered as a donor on his
driver's license, which came as an enormous relief, almost a gift, to
his parents. His donation reminded them of their son's generosity and
good-heartedness, qualities that his addiction had sometimes obscured.

"It absolutely turned things around for me," Mrs. Maleham said.
"Finding out that with his death someone else could benefit was such a

The impact has been striking, especially in a region like New England,
which is in the grip of a heroin and opioid epidemic.

So far this year, 69 people in New England who died from an overdose
have donated their organs, according to the New England Organ Bank.
They account for 27 percent of all donations in the region, up sharply
from 2010, when eight donors, or 4 percent, were drug users.

Because doctors can use multiple organs from each person, these 69
deceased drug users saved the lives of 202 other people, according to
the organ bank.

Nationwide, more than 790 deceased drug users have donated organs this
year, accounting for about 12 percent of all donations. That is more
than double the 340 drug users who donated in 2010, or about 4 percent
of the total, the organ bank said.

"It's an unexpected silver lining to what is otherwise a pretty
horrendous situation," said Alexandra K. Glazier, chief executive of
the New England Organ Bank, which procures organs for transplant in
the six New England states and Bermuda.

Drug users have long been considered high risk because they often
carry diseases like H.I.V. or hepatitis C. But at a time of a severe
organ shortage, the volume of organs available from overdose deaths
has led transplant centers to try to use them instead of throwing them
away. With rigorous screening, officials say, the risk of
transplanting an infected organ is small. Moreover, they say,
hepatitis C can be treated if not cured and H.I.V. made manageable.
Either is usually preferable to death.

"We know now that the mortality rate of being on the waiting list for
several years is higher than that of getting an organ with an
infection that is treatable," said Dr. Robert Veatch, a professor
emeritus of medical ethics at Georgetown University, who has written
extensively about organ transplants.

Rita Lottie, a 65-year-old grandmother with liver disease, said she
was at first "iffy" about the prospect of accepting a liver from a
high-risk donor.

But after a year on the waiting list, Mrs. Lottie was so sick that
when a liver whose donor had hepatitis C became available, she eagerly
accepted it.

"When you have a terminal disease, you look at things differently,"
said Mrs. Lottie, a retired teaching assistant who lives in northern
New York. In April she received a liver transplant at UMass Memorial
Medical Center in Worcester, Mass.

"I thought, if it gives me five to 10 more years, that's more than I
would have had," she said.

So far, she has not developed any infections and is healthier than
just before the transplant. She enjoys her grandchildren and
gardening, and is looking forward to her 46th wedding

Transplants were initially associated with deaths from car accidents,
which is why organ donors are noted on driver's licenses. But
overdoses (47,000 in 2014) have surpassed car crashes (32,000 in 2014)
as the leading cause of accidental death in the United States. The
growing numbers of overdoses from synthetic opioids like fentanyl and
carfentanil have only heightened the drug toll.

Drug users are now the fastest-growing category of donor. They rank
fourth, behind donors who died of strokes, blunt injuries and
cardiovascular problems.

But even as drug users are making a life-or-death difference for some
recipients, the need for organs remains vast.

There are 120,000 people on the national wait list for transplants.
While 85 people receive one every day, 22 others die every day before
a match is found.

One advantage of drug users as donors is that they tend to be younger
and healthier than other donors, said Dr. David Klassen, chief medical
officer for the United Network for Organ Sharing, which administers
the nation's organ procurement network.

Survival rates for recipients of a pancreas, liver or heart from drug
users from 2012 to 2014 were similar to those for recipients whose
donor had no history of drug use, according to the Organ Procurement
and Transplantation Network.

"The risk of actual infection transmission with current screening
strategies is numerically very, very small," Dr. Klassen said.

Dying of an overdose, which usually occurs when oxygen cannot reach
the brain, does not affect kidney function or other organs. The drugs
and blood are flushed from the organs when they are removed from the

Still, the Public Health Service considers organs from drug users to
be high risk, as it does those from prostitutes, people who have been
incarcerated and men who have had sex with men. For many years,
patients with H.I.V. and hepatitis C were not even considered
potential donors and their organs were thrown out, and some surgeons
still hesitate to use them.

"Putting a virus into a person is repulsive to many clinicians," Dr.
Veatch said. And in a litigious era when defensive medicine is the
norm, some doctors reject organs from high-risk donors.

While the transmission of infection is rare, it does occur. From 2006
to 2015, according to the Organ Procurement and Transplantation
Network, 249 of 174,388 recipients contracted a disease from their
donors, and 71 of them died.

Some were high-profile cases. In 2007, a single donor transmitted both
H.I.V. and hepatitis C to four organ recipients. It was the first time
in 20 years that H.I.V. had been conveyed in a transplant, and it
underscored the problem of tests failing to detect viral diseases if
they are administered too early.

But with intensive screenings, a thoroughly informed consent process
involving the recipient and the ability to treat most resultant
infections, more centers are accepting high-risk donors.

"The severe shortage of organs and imminent risk of death in some
patients are the basis for offering a hep C positive organ to a
patient who is not hep C positive," said Dr. Adel Bozorgzadeh, chief
of the division of organ transplantation at UMass Memorial, which has
a reputation for performing transplants on high-risk patients.

"With recent availability of highly effective treatment for hep C, it
makes sense to consider this approach for the occasional patient who
otherwise has, objectively, a very high risk of dying," he said.

For decades, knowingly transplanting organs from people with H.I.V.
was illegal in the United States. But the law was changed in 2013, and
this year surgeons at Johns Hopkins University Medical Center
performed the first transplants of organs from a deceased donor with
H.I.V. into two H.I.V.-positive recipients.

Recipients must be told if they are being offered an organ from a
high-risk donor. Whether they consent often depends on how sick they
are. If they decline, they do not lose their place on the waiting
list, although it may be quite some time before another match comes

David Sellers, 51, who works with computers in Worcester, has been
waiting for a kidney for a year. He is not yet on dialysis and says he
is in fairly good shape, although exhausted at the end of the day.

"If I were presented tomorrow with a high-risk donor, I would opt not
to accept it," he said. "I don't want to introduce another opportunity
for disease to ravage my body."

Still, he acknowledged that as his condition deteriorated, he might
become more receptive to "whatever I could get."

Arthur L. Caplan, head of the division of medical ethics at New York
University's Langone Medical Center, said potential recipients of
high-risk organs had to grapple with what he called "the coercive
nature of imminent death," meaning the sicker they are, the more they
may feel they have no real choice.

"If you're facing death and someone is throwing you a potential life
preserver," he said, "the less interested you are in who made the life
preserver and where it came from."
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