The Gift of Life: Organ Donation Amid America’s Drug Crisis

Alasdair Lane

Adam Shay loved to paint, just like Karen Goodwin. They even received an award at the same invitational art show, albeit 21 years apart. A mutual acquaintance, a former brother-in-law, is another uncanny connection between the two. And then there was their shared enemy: substance addiction. For Adam, it was a slippery slope from prescription painkillers to heroin; alcohol was Karen’s demon. Now, despite no familial relation, they share flesh and blood – Adam’s kidney and pancreas live on inside Karen.

Adam Shay was 21-years-old when he died of a drug overdose in his hometown of Mentor, Ohio. He was a victim of the US’s spiralling opioid crisis, which – five years on from his death – continues to worsen. Just weeks before his passing, Adam had signed up to be an organ donor, a decision that would include him in what some call the crisis’s silver lining – the surge of organ transplants from drug-deceased donors.

“I was actually the second person on the waiting list,” says Karen, a mother of one. The patient above her refused Adam’s “gift of life”, as she puts it, because his drug use made him a ‘high risk’ donor. Karen’s time was running short, but it wasn’t medical urgency alone that made her accept. “At the time I was 13 years clean and sober. I thought that receiving a pancreas and kidney from someone who had battled addiction and lost was meant to be”.

America’s opioid epidemic kills some 60,000 a year – far more than gun violence or traffic accidents. So grave is the crisis that it has contributed to three consecutive years of falling US life expectancy, experts say. But the unique physical circumstances of drug related deaths has offered hope to those languishing on the 120,000-strong transplant waiting list.

Overdoses tend to kill by starving the brain of oxygen, which, assuming the victim is hospitalised in good time, prevents their internal organs deteriorating too quickly. Couple this with the fact opioid users tend to be younger and otherwise healthy, it’s little wonder the number of overdose donors has increased more than twelve-fold since 2000.

But there remains a stigma around transplants from opioid victims, says Dr. Ann Woolley of Brigham and Women’s Hospital in Massachusetts, who’s authored a new report on the subject. Fears that their organs could carry blood-borne diseases like hepatitis C – which is associated with needle sharing – shouldn’t prevent their use in transplants, Dr. Woolley argues. “From our experience as well as from national analyses of transplant outcomes in the US, drug intoxication should not exclude [drug users] from being potential suitable organ donors,” she told Il Giornale.

In Karen’s case doctors rigorously tested the organs, allaying her fears of infection – and, as she frankly acknowledges, she would “have died without a transplant much quicker”. The fact that a would-be donor is registered as ‘high risk’ shouldn’t deter those in need, she argues, pointing out that petty crime offences can land someone in the bracket. Besides, contracting disease from organ donation is uncommon and there’s a high chance that any transferred illness would be treatable, Karen says.

This is a view shared by more and more clinicians. Between 2014 and 2017 the number of transplanted organs testing positive for hepatitis C increased by some 172%, the United Network for Organ Sharing (UNOS) reported. This, in part, was a response to the availability of powerful new antiviral medication that can rid the body of transferred infection after the operation is complete.

Dr Robert Montgomery, a transplant surgeon himself, is living testament to this. Suffering a terminal cardiac condition, Montgomery accepted a drug user’s heart that carried the hepatitis C virus. “I could have stayed in the hospital for months or even a year. You have to find a similarly sized person and the same blood group and there’s just not that many hearts available,” he said. As expected, Montgomery contracted hepatitis C – but after an intensive course of medication he was free of it just two months later.

Longer term, the outlook is good too. Dr Josef Stehlik of the University of Utah Health Sciences Center studied the recovery and survival rates of drug-related organ transplants. Little difference was found between these patients and those of more conventional donors, he told Il Giornale, noting that his “data would indicate [drug users’] organs are safe to transplant and likely to provide opportunity for many years of life for the recipients”.

For her part, Karen says she feels “incredible” five years on from the operation. She struggled to walk just ten paces prior to her transplant – now she travels all over the US and enjoys off-roading adventures and ziplining. “Immediately after my transplant it was like this fog I had been in for so long was gone,” she recalls. “Now my muscles don’t ache, I have more energy, and everyday is absolutely amazing and wonderful simply because I get to wake up!”

One thing she’ll never do is forget the human cost of her recovery. After the procedure, Karen connected with Adam’s family. From his mother Marlene, Karen learnt that he had been in and out of rehab prior to his death. Long battles with addiction can emotionally deplete a victim’s family, compounding their grief when their loved one passes. But amidst their sorrow, the Shays found gratitude. “Adam’s family actually thanked me for accepting his organs,” Karen says. “I didn’t understand it at first, but they said it means so much just to know that his last act on Earth was not that he was an addict or another number added to the list of ODs. He was a hero”.

Every year, Karen gives Marlene a coin to mark both her own and Adam’s sobriety. Talking about him regularly is important to them both – that way, “he will never be forgotten,” she says. And every so often, they volunteer together at the local organ procurement branch. To those thinking of becoming donors, Karen’s message is clear: do it. “We can all be heroes. We never know when our time to leave this world will come. I’m sure Adam didn’t expect to die at the age of 21, but because of him, I wake up grateful every morning”.