Durand CM, et al. - Experts characterized the donors who died of an overdose and evaluated the outcomes among transplant recipients. In the United States, a dramatic increase in the transplantation with overdose-death donor (ODD) organs was noted with noninferior outcomes in transplant recipients. Among donors, concerns about infectious risk donors (IRDs) behaviors and hepatitis C lead to excess discard that ought to be minimized given the current organ shortage.

Methods

• Authors conducted a prospective observational cohort study in a scientific Registry of Transplant Recipients, 1 January 2000 to 1 September 2017.
• They included138,565 deceased donors; 337,934 transplant recipients at 297 transplant centers.
• Donor mechanism of death (overdose-death donor [ODD], trauma-death donor [TDD], or medical-death donor [MDD]) was the primary exposure.
• Researchers compared patient and graft survival and organ discard (organ recovered but not transplanted) using propensity score-weighted standardized risk differences (sRDs).

Results

• As per the data, a total of 7,313 ODDs and 19,897 ODD transplants (10,347 kidneys, 5,707 livers, 2,471 hearts, and 1,372 lungs) were identified.
• In 2000, overdose-death donors accounted for 1.1% of donors and 13.4% in 2017.
• Findings suggested that they were more likely to be white (85.1%), aged 21 to 40 years (66.3%), infected with hepatitis C virus (HCV) (18.3%), and increased-infectious risk donors (IRDs) (56.4%).
• Compared with TDD organ recipients (sRDs ranged from 3.1% lower to 3.9% higher survival) and MDD organ recipients (sRDs ranged from 2.1% to 5.2% higher survival) standardized 5-year patient survival was similar for ODD organ recipients .
• Results demonstrated standardized 5-year graft survival to be similar between ODD and TDD grafts (minimal difference for kidneys and lungs, marginally lower [sRD, -3.2%] for livers, and marginally higher [sRD, 1.9%] for hearts).
• For ODDs, kidney discard was higher than TDDs (sRD, 5.2%) or MDDs (sRD, 1.5%); standardization for HCV and IRD status attenuated this difference.