‘we were wrong’: drug use and heart transplants

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using the hearts of drug users is safe and will cut waiting time and number of deaths among people waiting for transplants.

by dave yasvinski

published jul 28, 2021

last updated feb 20, 2025

3 minute read

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3 minute read

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drug use shouldn't prevent heart transplants

new research suggests the hearts of drug and alcohol users are safe for transplants. getty

a pair of studies has found that illicit drug use by heart donors prior to death does not affect the success rate of transplants and should not prevent the procedure from taking place.

the opioid epidemic currently plaguing the u.s. and canada may have increased the prevalence of potential heart donors but many of these vital organs have not been used over fears that illicit drug use — often the cause of death — will decrease the viability of a transplant. in 2019, the u.s. performed 3,552 heart transplants, the most recorded in a single year. canada, for comparison, performed 189 heart transplants in 2017, according to the canadian institute for health information. thousands of patients, on both sides of the border, are patiently waiting for more organs to become available.

“this research confirms previous data that these hearts — once considered high risk — are safe,” said howard eisen, the chair of the american heart association’s heart failure and transplantation committee of the clinical cardiology council. “these findings should encourage institutions who are not routinely using hearts from drug users to do so. it will reduce the waiting time and the number of deaths among people on the heart transplant waitlist.”

the first study, published in the journal circulation: heart failure, was the largest to explore the issue to date and only one to examine toxicology data from donors at the time of admission to hospital. the research, which examined more than 23,000 adult heart transplants, found the survival rate of recipients was comparable regardless of whether or not donors used illicit drugs prior to death. opioids, cocaine, methamphetamine, alcohol, barbiturates and amphetamines were among the substances detected in the urine of donors, with some testing positive for five or more substances.

“we thought that illicit drugs like cocaine or methamphetamine, which can lead to heart attacks, would prove to be dangerous,” said david a. baran, lead study author of the study and system director for advanced heart failure and transplantation at sentara heart hospital in norfolk, virginia. “however, we were wrong. we should not reject a heart from a donor just because they used one or more illicit drugs.”

the second study, published in the journal of the american heart association, encouraged the acceptance of hearts from donors who used drugs or had hepatitis c prior to death.

“we hope that patients who are awaiting transplants are encouraged to accept hearts from donors who had hepatitis c or who died due to a drug overdose, if their health care team finds the donor heart to be an appropriate match,” said ravi dhingra, lead author of the study and medical director of the heart failure and transplant program and associate professor of medicine at the university of wisconsin-madison.

hepatitis c, a viral infection of the liver that spreads through contaminated blood, can be treated with new antiviral medication that makes the virus more manageable, dhingra said. his team compared the survival rate of heart recipients from donors who died of an overdose or had hepatitis c to donors of hearts without these factors. the risk of death among transplant recipients between 2013 and 2017 was found to be 15 per cent lower than the rate of death between 2003 and 2007 at the one-month mark. it was 21 per cent lower one year later, proving the viability of the procedure and the necessity of including more organs in the process.

in a race against the clock, every heart makes a world of difference to recipients and their families. “about 20 per cent of patients on the heart-transplant waiting list die while waiting to receive a transplant or become too sick to remain good transplant candidates,” dhingra said.

dave yasvinski is a writer with healthing.ca