UTILIZATION OF DRUG OVERDOSE DONORS FOR LIVER TRANSPLANTATION DURING COVID-19 PANDEMIC

ABSTRACT

Background: The increasing number of deceased drug overdose donors (DOD) has paralleled the recent rise in the opioid epidemic, which has been further exacerbated by the COVID- 19 pandemic. While the transplant community has seen a rise in allografts donated by victims of drug overdose, we aim to characterize the recent shifts in DOD utilization during the pre-COVID and COVID eras. Methods: Using the United Network for Organ Sharing (UNOS) registry, we analyzed all adult recipients that underwent solid organ transplantation (SOT) including liver transplant (LT) in the United States from January 1, 2017 through June 30, 2021. The pre-COVID era was defined from January 1, 2019 to February 29, 2020 and the COVID era was defined from May 1, 2020 to June 30, 2021 (14 months each). We excluded March and April 2020 because transplant volume was adversely affected due to diversion of resources. DOD were identified using the UNOS variable that characterizes the mechanism of death of the donor. Tests of proportions and unpaired T-tests were performed to compare demographic information and clinical characteristics of DOD from the pre-COVID and COVID eras. Results: The number of donors for all SOT remained stable in the pre-COVID and COVID eras (14,029 vs 15,547). Likewise, the number of LTs remained stable (9,687 vs 10,096), reflected by a rise in DOD utilization. From the pre- COVID to the COVID eras, the utilization of DOD for SOT increased by 33% from 13.7% (n=1924) to 16.4% (n=2553) as shown in Table 1. This increase in DOD utilization during the pandemic was seen across all organ types with a significant rise for LT (pre-COVID n= 1465, 15.1% vs COVID n=1846, 18.3%;P<0.001). Among DOD, the percentage of young adult donors < 30 declined (31.2% vs 28.0%;P=0.022) in the COVID era. Similarly, the percentage of DOD with HCV seropositivity and HCV viremia decreased by 5.2% (34.3% vs 29.1%;P<0.001) and 4.3% (22.1% vs 17.8%;P<0.001) respectively. Regionally, there was a significant increase in DOD utilization in the South and Midwest (Table 1). Conclusion: The continued rise in the opioid epidemic has led to increased utilization of otherwise healthy DOD. This increase in DOD utilization has contributed to the steady transplant volume during the pandemic for all organ types, including LT. Fewer DOD with HCV during the pandemic reflects recent national trends. Unlike the early phases of the opioid epidemic, there is less of a regional distribution of utilization of allografts from DOD. (Table Presented)