*Purpose: Despite an increasing number of patients waiting for heart transplantation, the growth of transplant volume has risen slowly. The opioid crisis has resulted in a marked increase in donors of late, but many centers are hesitant to take donors with a history of drug use. We endeavored to investigate the frequency of specific drugs identified on toxicological testing among prospective heart donors.

*Methods: The UNOS heart transplant data file was obtained including the type in toxicology field which was recorded beginning in 2007. Using a custom database program, each toxicology record was manually reviewed and adjudicated for 21 drugs and a Measured Tox Score (MTS) created with one point for each drug. Drugs were: acetaminophen, amphetamine, barbiturate, benzodiazepines, buprenorphine, cocaine, ethanol, ethylene glycol, isopropanol, lithium, marijuana, MDMA, methadone, methamphetamine, methanol, opiates, phencyclidine, propoxyphene, salicylates, synthetic opiates, andtricyclic antidepressants. Utilization of donors based on individual drugs and the MTS were compared. Student’s t-tests were used to compare groups.

*Results: The database contained 51205 organ donors evaluated since 2007 where toxicology fields were available to analyze (table below). 55.9 % of donors had at least one drug identified on toxicology assays. The 5 most common drugs detected at the time of donor evaluation were benzodiazepines (25.1 %), marijuana (17.5 %), opiates (17 %), alcohol (8.9 %), and cocaine (8.2 %). More than half of all cardiac donors were rejected, with the lowest turndown rate for donors with alcohol, marijuana and benzodiazepine identified. Fewer donors had high MTS scores, with most having a score of 1-2. However, as MTS increased, the percentage of these donors offered for transplant also increased. The percent of turndowns increased as well but the net percent of transplanted hearts increased slightly. On average, almost 14 % of hearts were not offered in donors where other organs were evaluated. Only about a third of all donors were ultimately utilized for heart transplantation.

For each category of increasing MTS, the corresponding donor age decreased. The mean ± standard deviation age for donors by MTS score is as follows: MTS 0: 39.5 ± 17.2, MTS 1: 38 ± 14.8, MTS 3: 35.5 ± 11.9, MTS 5: 33.8 ± 11.3 years. (p<0.0001 ANOVA) Increasing MTS was associated with increasing male donor gender. MTS 0: 60.4 %, MTS 1: 64.9 %, MTS 3: 62.8%, MTS 5: 59.2 % (p<0.0001 chi-square).

*Conclusions: Toxicology testing at the time of organ donation demonstrated the presence of drugs in the majority of donors since 2007. Donors with increasing numbers of drugs detected had lower rates of utilization for transplant. However, a higher MTS score was associated with younger donor age and a higher number of male predominant donors which are traditionally positive influences on survival. Whether a positive donor toxicology report in the cardiac donor is associated with inferior outcomes needs to be investigated.

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