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Canada As death tolls rise, opioid crisis makes more organs available for transplant

Long before her son lay dying, Jill Martens spoke with her family about organ donation.

A nurse who works with people with chronic kidney disease, Ms. Martens knew the impact of such donations well.

“I’ve actually handed the phone to a patient while they were on hemodialysis, and it’s the kidney doctor phoning the patient to say, ‘I’ve got a kidney for you,’” says Ms. Martens, who started working at St. Paul’s Hospital in Vancouver when she was pregnant with her son, Daniel.

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Daniel Martens, the 23-year-old son of Jill Martens, who died in April 2016 of an overdose.

Jeff Bassett/The Globe and Mail

"I’ve seen the big grin on the patient’s face, I’ve done the dance around the patient, the whoop, the joy, everybody shouting and screaming – everybody jumping into action to organize everything and seeing people’s lives transform with a transplant.”

And so when Daniel suffered a fentanyl overdose in April, 2016, one week shy of his 24th birthday, that is where Ms. Martens’ mind went: “I said straight away: What about organ donation?”

The arrival of illicit fentanyl has spurred a devastating surge in overdose deaths; in 2017 alone, around 4,000 Canadians died of opioid overdoses. The soaring death toll has produced a tragic silver lining: an increase in organ donations that have saved the lives of countless others.

BC Transplant, the agency that oversees all aspects of organ donation and transplant in the province, in 2017 began collecting data on the presence of fentanyl in deceased donors. That year, 23 of the 121 who were examined, or 19 per cent, tested positive for the opioid at hospital admission. In the first three months of 2018, it was nine of 33, or about 27 per cent.

As fentanyl is not routinely tested for, it’s possible that the drug was a factor in other deaths for which it was not tested, according to BC Transplant.

In Alberta, 25 per cent of deceased organ donors in 2017 died from a drug overdose. That’s up from 17 per cent in 2016 and 10 per cent in 2015.

The Trillium Gift of Life Network, the agency that coordinates organ and tissue donation and transplantation in Ontario, keeps statistics on donors whose deaths were opioid related, though not for fentanyl specifically. In 2017, just over 8 per cent of 347 deceased donors died of opioid-related deaths. That compares with 3 per cent in 2016, 4 per cent in 2015 and 2 per cent in 2014.

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The United States, meanwhile, has seen a 24-fold increase in organ donations from people who died of drug overdoses since 2000. There were 149 transplants performed using organs from overdose victims that year; that climbed to 3,533 in 2016 – or 12.6 per cent of donors, according to a study published in April in the Annals of Internal Medicine.

Mike McDonald, a transplant cardiologist at the University Health Network (UHN) in Toronto, says he has seen transplantation wait lists shrink as a result of mounting overdose deaths.

Jill Martens at her Pentiction home. She lost her 23-year-old son Daniel to an overdose in April 2016.

Jeff Bassett/The Globe and Mail

“In our program, we’ve gone from transplanting about 25 hearts a year to – consistently, in the last three or four years – transplanting about 35 hearts a year,” he says. “That jumps out. It’s not quite a 50 per cent jump, but it’s close. And that’s being seen by our colleagues in Ottawa as well, and I would suspect across the country.”

Sean Virani, the division head of cardiology at St. Paul’s Hospital in Vancouver, says he has seen a “huge spike” as well: “Virtually every phone call I take these days around a potential donor is somebody who’s had an overdose.”

Organs from people who have died of drug overdoses are generally no more risky than organs from people who died of other causes. In fact, these organs tend to be “very good” because, tragically, most people who die of overdoses tend to be young, says Sean Keenan, medical director for donation at BC Transplant.

However, injection drug use comes with risks. For this reason, donors that partook in the practice in the five years prior to their deaths, such as Daniel Martens, fall into a category called “exceptional distribution.” That means they are an increased-risk donor.

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“The potential recipients are all made aware that despite all the tests being negative, there is a very, very small chance of transmission of something like hepatitis or HIV,” Dr. Keenan says.

Other prospective donors that fall into this category under Health Canada criteria include people who have done sex work in the past five years, men who have had sex with another man in the past five years and people who have been incarcerated for 72 hours in the past 12 months.

Organ donation and transplantation agencies say it is rare for potential recipients to decline an organ from donors in this category when offered, but it does happen. A 2015 article in the American Journal of Transplantation, for example, noted that only one in three available organs is accepted for heart transplantation in the U.S., with the majority of declined hearts from donors designated as increased risk.

For privacy reasons, potential recipients are not told that a prospective donor has died of a drug overdose. Patients are only told a donor is considered increased risk if they fall under the Health Canada criteria.

Mr. Martens relapsed after six weeks of rehabilitation and some time on buprenorphine-naloxone, known better by its brand name Suboxone. He had injected a fatal dose of morphine and fentanyl, and was found slumped over in his car in a Kelowna park.

At the hospital, Ms. Martens and her husband were met by a BC Transplant nurse who presented an organ donation card signed by their son. He had listened to his mother the many times she spoke of work – of finding a donor, the dance around the patient, the joy – and signed up to be a donor himself.

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“We all would have made that decision anyway," Ms. Martens says, "but the fact that he had signed his card, it just took a layer of agony out of the weekend. It made us so proud of him.”

Mr. Martens' lungs, kidneys and liver were all donated; they saved four other lives.

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