In their brief communication 1 , Goldberg and Lynch attempted to answer a vital question: is the 37% rise in deceased organ donation over the past decade solely attributable to the drug overdose epidemic?After close inspection, we find the authors' conclusion "it is indisputable that nationally the increased number of donors is almost wholly attributable to the drug epidemic" to be unsupported by the data.The authors anchored their analysis on a logical fallacy-that "drug-related" deaths are deaths in which the decedent had any history of drug abuse. This rationale is akin to designating car crashes involving drivers who ever drank alcohol as "DUI-related" accidents.Of the 24 888 donors classified in Table 1 1 as "Other mechanism of death; non-intravenous drug use," the OPTN database indicates that 9559 (38%) were reported as not having continued drug use within the past 6 months, based on an available data field apparently not considered by the authors. Furthermore, 4337 (17%) were reported as having head trauma as cause, "blunt injury" as mechanism, and motor vehicle accident as circumstance of death, making the classification of such deaths as overdose-related purely speculative. (OPTN data)The authors suggest that 102% of the rise in donation is attributable to the drug epidemic. Our calculations suggest that while the drug epidemic has certainly made an impact on donation, it is not the sole reason for the increase. Adapting to the epidemic by recovering >1000 more drug intoxication donors in 2018 vs 2009 itself reflects OPO and system-wide process improvement; the fact that the entire rise in donation cannot be linked to drug abuse opens the possibility that there have been meaningful improvements in other areas as well.The number of donation after circulatory death (DCD) donors rose 132% from 2009 to 2018, a trend closely linked to OPO performance improvement 2 . In 2018, just 12% of DCDs had drug intoxication as mechanism of death (OPTN data). Among non-DCDs, the number of organs transplanted per donor rose from 3.17 in 2009 to 3.34 in 2018 3 .Unjustifiably concluding that the donor increase is "merely the byproduct of circumstance" 4 may disincentivize efforts to identify and disseminate best practices that can boost system improvement. Further system improvement through spreading effective practices, policy changes, and developing better performance metrics is imperative.
