Opioid deaths and organ donation

Canada is experiencing an unprecedented drug toxicity crisis fueled by synthetic opioids like fentanyl, with more than 34,400 apparent opioid toxicity deaths between January 2016 and September 2022, according to the Canadian Centre on Substance Use and Addiction.A side-effect of that crisis has been an increase in deceased organ donations. In June 2021, Dr. Sean Keenan and colleagues reported in the Canadian Journal of Anaesthesiology that from 2014 to 2019, Canada saw a significant increase in the number and proportion of organ donors who died because of toxic drug ingestion. That research focused on Nova Scotia, Quebec, Ontario, Alberta and B.C., the latter two of which continue to show the highest rates of toxic drug deaths and resultant organ donations.“The proportional number of organ donors that have died because of the toxic drugs crisis is definitely higher now,” said Dr. Keenan, provincial medical director, donation services at BC Transplant. “Those deaths have increased the availability of organs, but of course, this is not a good thing,” added Dr. Keenan, who also works as an intensivist at the Royal Columbian Hospital in New Westminster, B.C.In B.C., 33% to 35% of organ donors have died as a result of toxic drug ingestion, said Dr. Keenan, who emphasizes that these are not drug overdoses per se, but the result of the toxic drug supply. “Every case of an organ donor is a tragic death regardless of how it happens, and the fact that we have this ongoing problem with a toxic drug supply is horrible.”The situation in Alberta is similar. According to Alberta Health Services, people who died from a drug overdose accounted for about 35% of deceased organ donors in Alberta in 2022. In 2017, that number was 25%. In 2019, it was 13% and in 2014, just 9%. Nearly 1,700 Albertans died last year from unintentional drug overdoses—an average of five deaths daily—compared with the pre-pandemic average of two a day.“Unfortunately, these tend to be younger people. They are usually reasonably healthy otherwise, and their organs are evaluated like any other donor. Their organs, besides their brains, tend to be healthy,” said Dr. Keenan. Overall rise in transplantsAccording to the government of Canada, a total of 2,936 solid organ transplants were performed in Canada in 2022, an increase of 6.8% compared to 2021 and a 31.4% increase compared to 10 years ago.Not all of the increase is attributable to drug deaths. The ability to treat using technological and medical advances that allow for organs to be transplanted from donors who in the past would have been excluded, such as those with hepatitis C, may also be a factor, as well as education and outreach.“One of the biggest increases in the last decade or so, why we have more organ donors aside from the toxic drug supply, has been the infrastructure that’s been put in place in provinces to help identify potential donors. A lot of work’s been done by Canadian Blood Services to pull people together to talk about it,” said Dr. Keenan.The push for more donors needs to continue, as there is still people dying on donor waitlist, and despite the increase in drug-death donors, only about 2% of such deaths go on to be donors, as often the victims are found dead and the resuscitation needed for viable organs is not possible.Increasing donations, he says, “comes down to engaging our ICUs and having (healthcare workers) be open to the idea that this is an option at end-of-life that should be offered to people. Clearly, physicians are focused on getting their patients well, that’s the priority. If it becomes clear a patient is not going to survive, we just want to make sure people are aware of this option.”

Opioid deaths and organ donation

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