The Impact of the COVID-19 Pandemic on Drug Overdoses in the United States and the Effect on Cardiac Transplant Volume and Survival.

OBJECTIVES: Drug overdose (DO) deaths rose to unprecedented levels during the COVID-19 pandemic. This study examines the impact of COVID-19 on the availability of cardiac allografts from DO donors and the implications of DO donor use on recipient survival.

METHODS: Heart transplants reported to the United Network for Organ Sharing (UNOS) from January 2017-November 2019 ("pre-COVID") and March 2020-June 2021 ("COVID pandemic") were analyzed with respect to DO donor status. Outcomes were analyzed using Kaplan-Meier survival and Cox-regression to identify predictors of survival. Characteristics of discarded cardiac allografts were also compared by DO donor status.

RESULTS: During the COVID-19 pandemic 27.2% of cardiac allografts were from DO donors versus 20.5% pre-COVID, a 32.7% increase (p<0.001). During the pandemic, DO donors were younger (84.7% vs. 76.3% <40 years, p<0.001), had higher cigarette use (16.1% vs. 10.8%, p<0.001), higher cocaine use (47.4% vs. 19.7%, p<0.001), and higher incidence of hepatitis C antibodies (26.8% vs. 6.1%, p<0.001) and RNA positivity (16.2% vs. 4.2%, p<0.001). While DO donors were less likely to require inotropic support (30.8% vs. 35.4%, p=0.008), they were more likely to have received cardiopulmonary resuscitation (CPR) (95.3% vs. 43.2%,p<0.001). Recipient survival was equivalent using Kaplan-Meier analysis (log-rank, p=0.33) and survival probability at 36 months was 85.6% (n. at risk=398) for DO donors versus 83.5% (n. at risk=1633) for all other donors. Cox-regression demonstrated that DO donor status did not predict mortality (HR 1.05; 95% CI 0.90-1.23, p=0.53).

CONCLUSIONS: During the COVID-19 pandemic there was a 32.7% increase in heart transplants utilizing DO donor hearts, and DO became the most common mechanism of death for donors. The use of DO donor hearts did not have an impact on short-term recipient survival.