The number of liver transplants performed in the United States did not decline during the first year of the COVID-19 pandemic, but the reason is unfortunate: A rise in drug overdose deaths led to an increase in the supply of donated organs, according to a presentation at Digestive Disease Week 2022.

According to the American Liver Foundation, about 6,000 liver transplants are performed in the United States each year—and nearly three times that many people are on waiting lists for donated livers. Common indications include fatty liver disease, hepatitis C, liver cancer and heavy alcohol consumption. In fact, liver transplants and waiting list registrations due to alcohol-related liver disease rose during the pandemic.

Many medical procedures have been delayed or curtailed during the pandemic due to the diversion of staff and resources and precautions to limit the spread of the coronavirus. But this was not the case for liver or other organ transplants.

“When the pandemic began, we saw no decline in liver transplants, which seemed surprising, since many surgeries were canceled or postponed,” lead study author Peter Lymberopoulos, a medical student at St. George’s University in Grenada, said in a DDW press release. “Sadly, a key reason seems to be a surge of organ donors who died from drug overdose.” 

As previously reported, nearly 108,000 people died of drug overdoses in the United States in 2021, representing a 15% increase from 2020 and setting a new record, according to the Centers for Disease Control and Prevention. Many of these deaths involved fentanyl, a potent synthetic opioid, but methamphetamine also played a role. People who die of overdoses are often young and have few other health conditions that would make their organs unsuitable for transplantation.

The researchers analyzed data from the U.S. organ donation registry maintained by the United Network for Organ Sharing. They looked at donor characteristics for all solid organ transplants during two 14-month periods—one before COVID-19 (January 2019 through February 2020) and the other after the pandemic was underway (May 2020 through June 2021). The analysis excluded March and April 2020, which saw the greatest COVID-related disruption at hospitals.

They found that the proportion of transplanted livers from donors who died of an overdose increased from 15% during the pre-COVID period to 18% during the pandemic—a 26% increase. For all solid organ transplants combined, the use of organs from donors who died of an overdose rose by 31%, from 14% during the pre-COVID period to 17% during the pandemic.

Although the study did not examine why more livers were available from people who died of overdoses, the authors suggested that pandemic-related socioeconomic stressors may have contributed to an increase in overdose deaths. 

“Among liver transplants, we found that the number of overdose donors rose at a surprising rate in the pandemic’s first 14 months, compared to the previous 14 months,” Lymberopoulos said. “Organ transplants are experiencing success, but it often comes at a cost. In many cases, that cost is primarily young males dying prematurely from overdoses.” 

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