Geospatial analysis of liver donation after death by drug intoxication

Increases in deaths from drug intoxication in the United States could be contributing to more liver donations. This study investigates regional variation in liver donation following death by drug intoxication over a decade. The number of drug intoxication-related deaths in the continental United States (2011-2020) was collected from CDC WONDER. Reports from UNOS provided the number of liver donors who died of drug intoxication over the decade. County-level ratios of liver donors after drug intoxication to the total number of drug intoxication-related deaths were calculated. Missed donation opportunities were quantified by comparing the actual number of donors to the hypothetical number if all counties achieved the efficiency of counties in the 90th and 50th percentiles. Regression analysis was used to assess the relationship between missed opportunities for liver donation per drug intoxication-related death and county-level variables. County-level proportions of liver donors after drug intoxication to all eligible drug intoxications ranged from 0 to 0.600. If every county matched the efficiency of the 90th and 50th percentile county, the liver donor pool could grow by 7572 or 1550 donors over the decade, respectively. The national rate of missed opportunities for a liver donation per death by drug intoxication was 0.114 or 0.022, depending on whether the 90th or 50th percentile donation ratio was used in the calculation. The number of missed donations per drug intoxication increased with higher social vulnerability, distance from a trauma center, and rural county status. Conversely, it decreased as the rate of deaths by drug intoxication rose. Assessing liver donation following drug intoxication allows for targeted efforts to increase donations in regions with the greatest potential for improvement.