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UBC Theses and Dissertations

Impact of the opioid crisis on transplantation in British Columbia, Canada; evaluating organ utilization and transplant outcomes for recipients of deceased donor organs from individuals who died from overdose Xie, Max Wenheng


Background Opioid overdoses, particularly from fentanyl are a growing public health crisis throughout North America. Canada recorded a staggering 21,056 opioid-related overdose deaths between 2016-2020. In the same period, compared to other provinces, British Columbia (BC) has constantly had the highest annual opioid overdose death rate. Individuals that experience fatal overdose are eligible to become organ donors. This study characterizes overdosed deceased donors (ODDs) and examines safety of outcomes for recipients of ODD compared to non-ODD organ transplantation in BC. Methods Data on deceased donors and their recipients were extracted from the Patient Records and Outcome Management Information System database from 2013-2019. Chart review was undertaken for each donor to determine whether drug overdose was the cause of death. We analyzed recipient outcomes for double-lung, heart, liver, and kidney transplantations. The Kaplan-Meier method was used to estimate unadjusted 5-year recipient outcomes. Donor, recipient, and transplant characteristics were balanced using inverse probability of treatment weighting. Weighted multivariable Cox proportional hazards regression models were used to estimate 3-year recipient outcomes comparing recipients of ODD and non-ODD transplantation. Results Between 2013-2019, 605 local deceased donors (457 non-ODDs and 148 ODDs) donated a solid organ to 1,795 transplant recipients resulting in 1,857 transplantations in BC. Compared to non-ODDs, ODDs were more likely to be young white males with fewer comorbidities such as hypertension and diabetes but have higher terminal creatinine and a greater prevalence of HCV. The probability of remaining event free at 5-year post-transplant for ODD double-lung (80%), heart (87%), liver (84%), and kidney (97%) recipients were high. ODD status did not affect recipient transplant survival in double-lung (hazard ratio (HR): 1.06, 95% confidence interval (CI): 0.41 – 2.70, p = 0.908) and liver (HR: 0.96, 95% CI: 0.42 – 2.20, p = 0.930) analyses but was inconclusive for hearts. Recipients of an ODD kidney saw significantly reduced risk of all cause graft loss (HR: 0.30, 95% CI: 0.12 – 0.77, p = 0.012). Conclusion In BC, overdose deaths and ODDs are increasing. ODD double-lung, liver, and kidneys have been shown to be safe for transplantation due to ODDs currently being mostly younger with fewer comorbidities.

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