It’s hard to fathom any goodness coming from the opioid crisis and the family tragedies it causes every day. But it does, in the form of an increase in organs available to people who need new hearts, livers, kidneys, and other organs.
By their ages only, many of those dying of overdoses would be considered in the prime of life. Their organs have years of vitality left, and can give the thousands of Americans on organ wait lists the chance for new lives.
We specialize in kidney transplantation. In the United States, about 20,000 kidney transplants are performed each year, too slow a pace for the 95,000 Americans waiting for new kidneys. Getting a donor kidney is a yearslong wait, and thousands succumb to kidney failure each year before a potential match becomes available.
Given the huge shortage of donors, it is bewildering and disheartening when an individual who needs a kidney declines one from a donor who died of an overdose.
Here’s why this happens: Before organs are removed from prospective donors, they are screened for hepatitis B and C, HIV, and other infections that might make their organs unfit for transplant. Even when no such infections are found, donors associated with any of the criteria the U.S. Public Health Service deems as risky must be identified as “increased risk.” The criteria include things like male-male sex, three consecutive days in jail, or non-medical injection drug use in the previous year.
The “increased risk” label signifies the potential that a donor contracted hepatitis B, hepatitis C, or HIV within a week of his or her death, raising the possibility that the infection wouldn’t be detected by screening.
According to guidelines set by the federal Organ Procurement and Transplantation Network, increased risk does not describe the quality of the donor organ or its likely longevity. And, to be clear, the risk of virus transmission from donor to recipient is slight — there’s less than a 1-in-1,000 chance that a recipient will contract hepatitis B, hepatitis C, or HIV from a donor kidney.
But “increased risk donor” is a powerful label, carrying the stigma of an overdose death. It wards off many people from accepting kidneys, often to their own detriment.
Consider a recent analysis that examined more than 100,000 instances of kidney transplant candidates declining increased risk donor kidneys. Five years later, 20 percent of those candidates had died and 15 percent were still on the wait list. Thirty percent went on to receive a standard-risk kidney, but those organs had worse functional scores, on average, than the so-called increased risk kidneys those patients had turned away. You read that right: The kidneys of people who overdose are, on average, no worse than standard donor kidneys and in many cases are healthier.
The analysis concluded that accepting an increased risk donor kidney “was associated with substantial long-term survival benefit.”
We share this information and more with our transplant candidates. We make every patient aware of the risks of transplant, especially those involving the prospective donor organ. We tell them we cannot guarantee that any donor organ, even one from a healthy person who never drank alcohol or used drugs illicitly, will succeed. We tell them about medications that, in the exceedingly small chance of virus transmission, would eradicate the condition (hepatitis C) or make it manageable (HIV or hepatitis B).
We hope they’ll see why it makes sense to accept an increased risk donor kidney and get off dialysis or avoid it, as well as detach from the emotional burden of waiting for a donor kidney to appear.
That logic doesn’t sway everyone. “I don’t need another problem,” fairly characterizes the mindset of transplant candidates who declined increased risk donor kidneys in our recent study of patients’ decisions.
“I didn’t want to get one of these diseases and maybe pass it to my family,” said one woman who underwent dialysis for more than three years and declined multiple increased risk donor organs before finally accepting one.
She later acknowledged that the education we provided reduced her “what-if” fears. In that way she represented the 92 percent of patients in our study who had declined an increased risk donor kidney but, after learning more, said they would be more open to accept such an organ in the future.
It is a shame that our culture has so stigmatized drug use that kidneys from people who die of opioid overdoses are routinely turned away by those whose lives might depend on these organs. That the altruistic intention of those donors or the generosity of their families could be spurned by a misunderstanding. That fear could so overwhelm probability.
If we could see these increased risk donors — as well as all people addicted to opioids — as victims of a disease, we could honor them for their precious gifts of life, just as we honor every other organ donor. It’s something to think about as both populations, drug-overdose victims and people who need kidney transplants, show few signs of shrinking.
Vanessa L. Weiland, M.S.N., is an advanced registered nurse practitioner and teaching associate in nephrology at the University of Washington School of Medicine. Lena Sibulesky, M.D., is a transplant surgeon and associate professor of surgery at the University of Washington School of Medicine.
I have 3rd stage kidney disease. I could live a long time with this, and die from something totally unrelated. But if I do get to the point where I make a choice between a heavily compromised life (or death) and a kidney from someone who died of drug overdose, I do not think I would hesitate to choose the kidney. I’ve known several people who contracted HepC or HIV, not through drug use, but through some other means of exposure. None of them did anything to make this happen; many are health care professionals. Treatment has either eradicated the disease or kept it manageable. If they can, I can, if it comes to that.
Five years ago my brother was diagnosed with stage 4b cancer. He chose radical surgery and radiation and chemo therapy. This last summer his doctors considered his cancer in full remission. It still is, but two months later, in a routine scan, a shadow was found on his liver, subsequently diagnosed as a different, unrelated cancer. He faces, at minimum, resection of his liver to remove the mass. We hope it is localized, but regardless, he is facing a new treatment plan and years of chemo. Again. Or, depending, a liver transplant along with all the uncertainties that entails.
My brother, who is younger than I, is my role model. He chose life. If he can make those choices out of love of life and the desire to spend more time on this earth with his family and friends, so can I. And I can honor the life of someone who perhaps made some poor choices by accepting a kidney that will prolong – and enhance – my life.
One more thing: over 30 years ago, I contracted Lyme disease, complicated by two or three other tick-borne diseases. I was ignored by doctors who dismissed my symptoms. I went misdiagnosed and untreated for 18 years, and was disabled, sometimes bedridden. My life disintegrated. When I was finally correctly diagnosed and aggressively treated, I clawed my way back to my life with the help of my family and of doctors who courageously rejected the “standard” treatment. I feel so joyful at having been given a whole life again- no way am I going to let it slide away for so long as my body will continue to function well enough for me to participate in this world.
When my time comes, I am willing to let go. Until then, if the rest of my body is up for it, I’ll take the kidney.
May I offer some inspiration today, the story of a living donor, with an upbeat, very positive outcome: https://www.nephtalk.org/nephtalk-magazine/2018/may/an-act-of-love-donating-a-kidney-giving-your-hea/
It looks like there is no end to the ways they cash in on the opiate epidemic. The very same medical personnel that heartily stigmatized overdose victims, and conflated chronic pain with opiate addiction, are now concerned. The media had a big part in this stigma, they sensationalized it in order to engage readers. A local hospital treating infants born to addicted mothers, even referred to the innocent babies as drug addicted, as if they were holding up liquor stores for a fix.
The Medical Industry which includes Doctors and Nurses, are responsible here. They allowed this kind of ignorance to persist. A misinformed general public along with willfully ignorant politicians, is usually profitable. Years of labeling stigmatizing and generating headlines with alternate facts, might have a downside.
This one baffles me. These people are on the terminal list for sure but when given a lifeline they refuse it??
I guess I have been in oncology for too long where my patients would eat rat dung and wash it with bear urine if I even HINTED it might be of value.
Since the science behind organ transplant failure is FAR greater death from rejection then from dysfunctional organ or side effect take ANY option that comes your way and then deal with the small “glitches” that might come with it if they do when they do.
The advent of getting Hep C from a kidney as currently screened is minimal and even if one does we have drugs to fight it same with Hep B and even HIV
Sure beats 3 or 5 days a week connected to a dialysis machine waiting to die
This goes for hearts livers eyes etc.
Come on folks we can[‘t be beggars and be choosy at the same time. Life is precious grab all you can
Dr. Dave (Surgical H&N Oncology)
I believe it comes down to two things: 1. By attending dialysis the patients think they’re being taken care of (possibly forever) and don’t see the mortality stats of dialysis patients. 2. The stigma of contracting HepC or HIV.
Dr. Dave may know oncology, but not nephrology. I do peritoneal dialysis, work full time, and live an almost a normal life. I’ve been offered high-risk kidneys. Doctor assurances of how they can beat whatever junky illness infect high-risk kidneys do not impress me.
I’ve burned through two kidney transplants already. Both were ideal–a living donor and an optimal deceased donor. One worked for 5.5 years and the other for 2. My doctors couldn’t stop the humoral rejection of the first one and they couldn’t fix the CMV infection that killed the other. Sorry, but I’m not adding the hep alphabet and HIV to my troubles. I’ll keep waiting, either for a low-risk donor or an artificial kidney. Give your junky kidneys to some miserable husk at a hemo climic who has no alternative, but don’t go assuming that everyone who says no is an ignorant ninny.
(I’ll also point out that oncology patients are, by definition, predisposed to do everything to stay alive a little longer. However, some of us value quality of life over length, and, aside from an initial consultation, would never visit you again. Some prefer to have a little excellent ice cream than a bucket of that low-quality crap from supermarket.)
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