Effects of drug abuse, smoking and alcohol on donor hearts and lungs

Abstract

Potential heart and lung donors with a history of illicit drugs and/or smoking and alcohol are frequently offered, though there is no clear guidance on when it is safe to use these organs. A review of the literature on effects of drugs, alcohol and smoking on donor outcomes, and the effects of these on the intact heart and lung was undertaken. There has been a marked increase in deaths from opioid abuse in many developed countries, though recent evidence suggests that outcomes after cardiothoracic transplantation are equivalent to nonopioid donor causes of death. For donor smoking, there is an increased risk with lung transplantation; however, that risk is less when compared to further waiting on the transplant list for a nonsmoking alternative. Heavy alcohol consumption does not adversely affect heart transplantation, and there is no clear evidence of adverse outcomes after lung transplantation. There are no overall effects of cannabis or cocaine on survival after heart or lung transplantation. In all these cases, careful donor assessment can establish if a particular organ can be used. In most cases, use of drugs requires careful assessment, but is not in of itself a contraindication to cardiothoracic transplantation.

Intoxicated Donors and Heart Transplant Outcomes: Long-Term Safety

“… 16 Recent publications support this and none show a difference in outcome with chronic alcohol use. 12 , 13 , 28 The current study also supports the safety of such donors and should alleviate concerns about using hearts from donors with a history of significant alcohol use.…”

Epithelial barrier hypothesis: Effect of the external exposome on the microbiome and epithelial barriers in allergic disease

“…In vitro studies have shown that tobacco causes rapid lipid peroxidation in the rat tracheal epithelium and is associated with alveolar epithelial damage in guinea pigs 344,345 . In lung transplantation studies, impaired alveolar clearance in the lungs of a smoker or ex‐smoker donor, expressed ex vivo , indicated alveolar epithelial damage and was associated with primary graft failure 346,347 . Even though e‐cigarettes are marketed as alternatives to aid smoking cessation, there is not enough evidence to show that they help.…”

“…344,345 In lung transplantation studies, impaired alveolar clearance in the lungs of a smoker or ex-smoker donor, expressed ex vivo, indicated alveolar epithelial damage and was associated with primary graft failure. 346,347 Even though e-cigarettes are marketed as alternatives to aid smoking cessation, there is not enough evidence to show that they help. Moreover, their safety is questionable as they contain a number of toxic chemicals such as benzene, ethanol, iron, aluminum, cadmium, tobacco-specific nitrosamines, polycyclic aromatic hydrocarbons, and formaldehyde, in addition to their four main components: nicotine, propylene glycol, glycerol, and food flavorings.…”

A narrative review of the impact of donor factors and selection criteria on outcomes after lung transplantation

“…Donor use of alcohol and other substances such as opiates, cocaine, amphetamines, and marijuana does not seem to lead to clinically important differences in survival compared to conventional donors (15,56). However, for donors with a significant history of cocaine or amphetamine use, donor EKG and echocardiogram should be reviewed carefully for any signs of pulmonary hypertension (56).…”

“…Donor use of alcohol and other substances such as opiates, cocaine, amphetamines, and marijuana does not seem to lead to clinically important differences in survival compared to conventional donors (15,56). However, for donors with a significant history of cocaine or amphetamine use, donor EKG and echocardiogram should be reviewed carefully for any signs of pulmonary hypertension (56). While donor marijuana use in itself does not seem to affect outcomes after transplantation, at least one recent study suggests that marijuana inhalation in conjunction with smoking, may have an additive adverse affect on recipient survival (HR 2.97) and use of donors that smoke tobacco products and marijuana needs to be considered carefully (55).…”