The US organ donation system has received attention from the highest levels of government. It has been debated whether increased donation is attributable solely to the opioid epidemic, or to broader performance improvements of the 58 OPOs. We evaluated Organ Procurement and Transplantation Network (OPTN) data of all deceased donors from 1/1/2009 to 12/31/2018. We hierarchically created four categories: (a) donor's mechanism of death coded as “drug intoxication” by the OPO; or donor coded as another mechanism of death but his/her history noted (b) intravenous drug use, (c) non-intravenous drug use (eg, snorting), or (d) no drug use. The first three categories were grouped as “drug-related.” In 2018, there were 2700 more deceased donors than 2009. While the number of donors dying from a non–drug-related death decreased by 52, the number of drug-related deaths increased by 2752 (102% of increase from 2018 vs 2009). While there have been improvements in performance at some OPOs, based on these data it is indisputable that nationally the increased number of donors is almost wholly attributable to the drug epidemic, and reflects the byproduct of a national tragedy, rather than an improved system to be celebrated.
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