*Purpose: The worsening opioid crisis in the United States has increased the availability of organs from donors who died of drug overdoses. The goal of this study was to estimate the years of life gained by recipients of transplants from victims of overdose deaths, to compare these gains to those from other donor mechanisms of death, and to understand how differences in donor age distributions and allocation patterns contribute to differential impact of organs by donor type.

*Methods: We accessed data from the Organ Procurement and Transplantation Network (OPTN) tracking recipients of solid organ transplants (kidney, liver, lung and heart) from deceased organ donors across the United States in 2019. Recipients were further stratified by the mechanism of donor death (MOD), donor age at death, and recipient age at transplant. We estimated the average years of life gained per transplant recipient for each organ type, using pre- and post-transplant mortality rates from the Scientific Registry of Transplant Recipients (SRTR). Years of life gained were summed for recipients by year, organ type, and donor mechanisms of death.

*Results: In 2019 there were 1,604 organ donors who died of drug overdose deaths and 4,906 transplant recipients receiving heart, lung, liver, or kidney from these donors. Overdose death donors contributed an average of 3.4 organs each compared to 3.6 per donor dying of other accidental causes (i.e. blunt injury, gunshot wound, asphyxiation MODs) and 2.4 for donors dying of natural causes (i.e. cardiovascular, stroke, natural causes MODs). We estimated that of the total 250,000 years of life gained (YLG) by transplant recipients in 2019, roughly 35,000 (14%) were contributed by overdose-death donors. On average, each overdose donor contributed an estimated 21.7 YLG compared to 28.3 YLG per other accidental death donor and 15.3 YLG per natural death donor. Across organ types, there were fewer YLG per transplant recipient from drug overdose donors compared to other accidental death donors. In addition, we found that the age difference between donor and recipient was significantly larger for transplants from drug overdose donors compared to donors with other MOD.

*Conclusions: Although donors deceased from drug overdose each contribute an estimated 22 years of life gained across all recipients of organs they donate, we found that fewer years of life were gained per drug overdose donor than from other accidental death donors. This may be due to differences in the number of recovered organs that are transplanted per donor, or differences in the age patterns of organ allocation between different donor mechanisms of death.

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