New Developments in Organ Donor Restrictions - New Jersey Anesthesia Professionals
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New Developments in Organ Donor Restrictions

            The most common reasons for a heart transplant are severe heart failure or improper functioning of one or both ventricles of the heart (Norton, 2021). A record-high 3,552 heart transplantations were performed in the United States in 2019, and the number of patients on the waiting list has only grown in recent years: according to the American Heart Association (AHA), 3,661 people were waiting for a heart transplant as of March 11, 2020 (American Heart Association, 2021). Due to America’s decades-long opioid crisis, a growing percentage of potential donor organs come from individuals who died from a drug overdose. Many of these hearts go unused because of the concern that illicit drug use during the donor’s lifetime may decrease the chances of survival for the heart transplant recipients. But two new studies published this summer find that donor hearts from individuals who used illicit drugs or died from overdose are safe for transplant, providing support for loosening organ donor restrictions (Becker’s Hospital Review, 2021).

            The data used in the first study, “Intoxicated Donors and Heart Transplant Outcomes: Long Term Safety,” was requested from the United Network for Organ Sharing (UNOS) database; UNOS maintains a registry of organ transplant activity in America, along with information about recipients, donors, and illicit drug use among those organ donors. Researchers examined the toxicology data of donors and compared survival after heart transplant for more than 23,000 transplant recipients between January 1, 2007, and December 31, 2017 (Baran et al., 2021). At the conclusion of the study, the researchers found that among donors who were accepted for transplantation, “neither history nor toxicological evidence of drug use” was associated with significant differences in recipient survival (Baran et al., 2021). The percentage of transplant recipients who survived was comparable between transplant recipients who received their heart donations from donors who used illicit drugs and those who did not. “We thought that illicit drugs like cocaine or methamphetamine… would prove to be dangerous,” explained lead study author Dr. David A. Baran (Baran et al., 2021). “However,” he continued, “we were wrong.” Baran said he hoped the findings would help “move the needle” toward removing restrictions on the use of hearts from this category of potential organ donor (Norton, 2021).

            The second study, “National Trends in Heart Donor Utilization Rates: Are We Efficiently Transplanting More Hearts?,” compared data from 2003-2007 to data from 2013-2017. The objective was to determine whether the potential donor pool should include donors who died from drug overdoses or had hepatitis C, a viral liver infection (Dharmavaram et al., 2021). Using the UNOS database, the Wisconsin researchers compared the survival of heart transplant recipients whose donors died from a drug overdose or had hepatitis C to the survival of transplant recipients whose donors had not died of a drug overdose nor had hepatitis C. Compared to the 2003-2007 group, heart organ donors from 2013-2017 were more likely to have used illicit drugs and were at higher risk for hepatitis C (Dharmavaram et al., 2021). Still, the risk of death among transplant recipients in the second group was 15% lower one month after their transplant than the recipients in the first group; one year later, their risk of death was 21% lower (Dharmavaram et al., 2021). According to Dr. Howard Eisen, chair of the AHA’s Heart Failure and Transplantation Committee, this research “confirms previous data that these hearts – once considered high risk – are safe (Norton, 2021).” As it stands, roughly 20% of patients on the waiting list for heart transplants die before they receive a transplant or become too sick to remain good candidates (American Heart Association, 2021). Reevaluating restrictions to be able to use of donor hearts from donors who used illicit drugs may help address the chronic organ donor shortage and the number of deaths among people on the transplant waitlist.


American Heart Association. (2021, July 28). Hearts from donors who used illicit drugs or overdosed safe for transplant, cuts wait time. ScienceDaily. Retrieved from

Baran, D. A., Lansinger, J., Long, A., Herre, J. M., Yehya, A., Sawey, E. J., Badiye, A. P., Old, W., Copeland, J., Stelling, K., & Copeland, H. (2021, July 28). Intoxicated Donors and Heart Transplant Outcomes: Long-Term Safety. Circulation: Heart Failure. doi:10.1161/CIRCHEARTFAILURE.120.007433

Carbajal, E. (2021, July 28). Donor hearts from illicit drug users safe, research finds. Becker’s Hospital Review.

Dharmavaram, N., Hess, T., Jaeger, H., Smith, J., Hermsen, J., Murray, D., & Dhingra, R. (2021, July 28). National Trends in Heart Donor Usage Rates: Are We Efficiently Transplanting More Hearts?. Journal of the American Heart Association. doi:10.1161/JAHA.120.019655.

Norton, A. (2021, July 29). Hearts from drug abusers can be used for transplants. U.S. News & World Report.