IMPACT OF DONOR OVERDOSE DEATH ON HEART TRANSPLANTATION OUTCOMES IN BRITISH COLUMBIA

BACKGROUND In Canada, 3,799 opioid-related deaths were recorded in 2019, and this number remains elevated since the overdose emergency was declared in June 2016. British Columbia (BC) has the highest overdose death rate in Canada. Individuals who died after an overdose are eligible to donate organs for transplantation. This study aims to 1) examine the number of overdosed deceased heart donors (ODDs) over time and 2) examine the safety of ODD heart transplantation in BC. METHODS AND RESULTS We studied heart transplant recipients in the Patient Records and Outcome Management Information System from 2013 to 2019. Chart review was conducted to ascertain the cause of death. We examined longitudinal trends in the number of transplants after ODD heart donation. Kaplan-Meier and inverse probability of treatment weighted Cox-proportional hazard regression analysis (accounting for differences in donor and recipient factors) were conducted in the first 3 years post-transplant to examine the association of cause of donor death (ODD vs non-ODD) and recipient survival. During the study period, the proportion of transplants from ODDs increased from 0% to 30%. Of the 113 recipients, 73 (65%) received non-ODD hearts and 40 (35%) received ODD hearts. ODDs were less likely to have comorbidities such as diabetes (0.0% vs 2.7%) and hypertension (5.0% vs 12.3%), and the incidence of HCV positivity was low among ODD donors (n=2, 5%). Recipients of ODDs were older than non-ODDs (48% vs 37% were ≥60 years respectively), and more likely male (75% vs 64%). Crude 3-year survival was high in both groups (87.9% and 90.2% for ODD and non-ODD hearts respectively, p=0.65) Weighted cox models accounting for differences between groups, showed no significant difference in risk of death (HR: 1.66; 95% CI 0.76, 3.62, p = 0.203). CONCLUSION Heart transplantation from donors who died as a result of overdose death has increased significantly in the last decade. Survival after ODD heart transplantation is high and similar to survival after transplantation from non-ODD donors. As the number of individuals dying after overdose remains increased, organs from these donors should continue to be used to reduce the time on the wait-list.