Donor substance abuse history (opioids, marijuana, cigarettes) did not worsen lung transplant outcomes or recipient survival, though cigarette smoking reduced the likelihood of donor lung acceptance.
Read this if you are awaiting a lung transplant or work in organ donation and want to understand how donor substance use affects outcomes.
Equivalent survivalRecipient survival was the same regardless of donor substance abuse history
What the researchers found
Among 3,515 donor offers, substance abuse donors were younger, more often male, White, and had hepatitis C. Cigarette smoking history significantly reduced donor acceptance odds (OR 0.56), as did any substance abuse history (OR 0.50) and hepatitis C (OR 0.35). However, opioid use, opioid overdose death, and marijuana use did not independently affect acceptance rates. Critically, recipient survival was equivalent when using lungs from donors with opioid overdose death, marijuana use, or cigarette smoking history. Opioid use donors actually showed longer recipient survival. No difference in time to chronic lung allograft dysfunction was found.
Why it matters
The organ donor shortage costs lives. If substance-using donors' lungs work just as well, rejecting them based on use history alone unnecessarily limits the donor pool. This is especially relevant as opioid overdose deaths have increased the potential donor supply.
The numbers in context
- 3,515 donor offers reviewed (2013-2019)
- 4.4% involved opioid use; 3.3% opioid overdose death
- 65% smoked cigarettes; 2.6% smoked marijuana
- Smoking OR for acceptance: 0.56
- Any substance abuse OR: 0.50
- Recipient survival equivalent across all substance categories
- No difference in chronic lung allograft dysfunction
How the study worked
Retrospective single-center review of all donor offers from 2013-2019. Compared acceptance rates and recipient outcomes by donor substance abuse categories using logistic regression and survival analysis.
Who was studied
3,515 lung donor offers to a single transplant center (2013-2019)
What this study cannot tell us
Single-center study with institutional biases in donor selection. Marijuana use prevalence may be underreported. The study cannot determine if there are long-term effects beyond the follow-up period. Substance use categorization relied on donor records which may be incomplete.
How to read the evidence
Large single-center retrospective cohort. Strong sample size with clinical outcomes but limited by single-center design and potential selection bias.
When this study was published
Published in 2023. Addresses an increasingly relevant question as substance-related deaths contribute more donor organs.
The bigger picture
The opioid epidemic has paradoxically increased the potential organ donor pool. Studies like this are crucial for reducing stigma-based barriers to organ utilization and ensuring that life-saving transplants are not unnecessarily declined.
Questions still open
- Should transplant programs update their acceptance criteria to explicitly include substance-using donors?
- Does heavy long-term marijuana smoking (not captured in this study) affect lung transplant outcomes?
- Could ex vivo lung perfusion technology further expand acceptance of substance-exposed donor lungs?
Read the original research
Outcomes of lung transplantation from donors with a history of substance abuse.
The Journal of thoracic and cardiovascular surgery, 165(1), 384-395.e4
Citation
Donahoe, Laura L; Cypel, Marcelo; de Perrot, Marc; Yeung, Jonathan; Wang, Stella; Pierre, Andrew; Waddell, Thomas K; Yasufuku, Kazuhiro; Keshavjee, Shaf. (2023). Outcomes of lung transplantation from donors with a history of substance abuse.. The Journal of thoracic and cardiovascular surgery, 165(1), 384-395.e4. https://doi.org/10.1016/j.jtcvs.2022.08.016