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Bittersweet outcome: Opioid epidemic leads to more organ transplants
PITTSBURGH — After the horror of watching their 26-year-old son, Patrick McKallip, battle opioid addiction for six years before he finally died May 24, 2016, of an overdose, Michelle and Anthony Donatelli found some solace 10 months later.
The day he died at Allegheny General Hospital, they decided to donate his organs. Later, they sent letters to the recipients of his kidney, liver and heart, hoping they would hear back from them.
The first to reply was a man in his 60s who received McKallip’s heart, saving his life. The Donatellis, from New Kensington, went to visit him in his Pittsburgh area home in March.
“He tells us every day (he exercises) he says, ‘Come on Patrick, let’s go for a walk,’” recalled Anthony Donatelli, who became McKallip’s stepfather when McKallip was 7.
“The heartache continues. It’s like an open wound. It just never closes,” Anthony Donatelli said of losing his son. “But after that (because of the organ donation) you realize he gave the greatest gift you could give anybody: Life.”
That bittersweet situation has been replayed in ever-rising record numbers over the last three years in Western Pennsylvania, Appalachia and the entire country.
In a rising tide of tragedy with no end in sight, figures through half of this year point to another record year locally and across the country in 2017.
The number of donors who died of overdoses more than doubled across the country from 625 in 2014 to 1,263 in 2016, and is projected to rise to about 1,400 this year, according to federal data. That same data shows that most of that increase came from Appalachian states like Pennsylvania, the Northeast and the Midwest, which tracks with where the opioid epidemic has hit hardest.
“It’s tragic,” said Dr. David Klassen, chief medical officer for the United Network for Organ Sharing, the organization that oversees the nation’s organ transplant system. “But (by recovering the increased number or organs) we’re trying to salvage a young person’s tragic death.”
The dramatic rise in organ donations is the reason CORE set a record for the number of deceased donors from any cause — 237 — in 2016, which also meant a record number of people received life-saving organ transplants.
“‘Record.’ It sounds strange to say it that way,” said Kurt Shutterly, CORE’s chief operating officer. “I’d rather say that we had more donors than we ever had. It’s sad. It’s just tragic what is happening.”
With no expectation that it will slow down this year, CORE in January approved increasing the number of organ procurement coordinators — the employees who go to the hospitals to try to convince families to donate organs and to evaluate the organs themselves — from 15 to 20.
“We’re evaluating more drug-related deaths than ever before,” said Shutterly, who began with CORE in 2000 as an organ procurement coordinator. “And I don’t see anything changing that right now and that’s a tragedy.”
Gift of Life, the organization that recovers organs in eastern Pennsylvania, as well as Delaware and a portion of New Jersey, serves a much larger population than CORE.
It has seen such a dramatic increase in donors from overdoses than the 121 cases it had in 2016, that it represented 10 percent of all such cases across the country.
“Last year is the first year that (drug overdoses) were a leading mechanism of death for our donors,” said Rick Hasz, Gift of Life’s vice president for clinical services.
Just six years ago, drug overdoses were a distant fifth, behind stroke and hemorrhage, cardiovascular, blunt injuries and gunshots. But if the growth continues at the same pace this year as it had in recent years, overdoses could be the leading mechanism of death in Gift of Life’s region.
One reason for that rise, Hasz said of research he will be presenting soon at a conference, is “that people dying of drug intoxication are more likely to have a donor status on their driver’s license than people in other categories.”
That is generally because people who die from overdoses tend to be younger — in their late 20s or early 30s on average — compared to people who die of the other leading mechanisms of death — who are typically in their 40s and 50s.
Older people who die are less likely to sign up to be a donor “because they don’t think anyone would want their organs, and they didn’t grow up in the transplant world,” which only became regular surgical practice in the last 30 years, Hasz said.
The result, he said, is that the “conversion rate” of people who die of an overdose, are medically qualified for donation, and who ultimately donate organs, is much higher — about 80 percent — than the overall rate of about 60 percent.
Not that long ago, organs from people who died of drug overdoses might have been thought of as a much riskier proposition than they are now.
Intravenous drug users could have been infected with HIV or hepatitis. Until about a decade ago, the only way to test for those infections was to look for the antibodies for either HIV or hepatitis in the donor.
Antibodies for both diseases don’t show up in a person for weeks after the initial infection: about three weeks for HIV, and about a month-and-a-half for hepatitis. That means that if a donor had been infected any time within that three- or six-week “window,” the recipient would be accepting the risk that even though the infection was not yet visible, it might be passed on to them through the transplanted organ.
“But the technology for screening for infection has made very, very significant improvements since then,” Klassen said.
The use of nucleic acid testing, which allows doctors to look into the genetic material of a donor’s cells to look for infection, had become standard at many places like CORE over the last decade. Five years ago, UNOS mandated that every person who donates an organ across the country go through nucleic acid testing.
Instead of a three-week window risk of infection for HIV and six weeks for hepatitis, nucleic acid testing can tell if a person contracted either infection in about a week before they died.
“While that still leaves a higher percentage risk, in fact the absolute risk of transmitting infection is very low,” Klassen said.
UNOS also wants to make sure people understand that, he said, because: “These donors tend to be very good donors. They are typically younger and otherwise healthy.”
That was certainly true of Patrick McKallip.
He grew up in New Kensington and from the time he was a year old, “his grandmother played baseball with him every day,” said Michelle Donatelli.
Baseball became his passion, and at 6-foot-3 he was a powerful bat, playing all through high school where he also got good grades. After graduating from Valley High School in 2007, he went to West Virginia University, where he initially wanted to get into pharmacy school.
“Before that, he never had any problems. He was just like any other teenager,” Anthony Donatelli said.
But in Morgantown, “that’s where everything started,” Anthony Donatelli said. At first, it was pain pills, opioids he got from friends at school, not through a prescription.
“He came home for the holidays and you’d see a difference,” he said of his son.
Two years into college, he dropped out and moved home, living in an apartment in New Kensington near his grandmother’s home.
Over the next six years, he was in and out of addiction, a roller coaster that followed his work life: When he got work during construction season in the spring through fall, he tended to stay off drugs; when he was unemployed in the winter, he got back on them, his parents said.
In 2012 he was arrested for four robberies of opioids from pharmacies in the New Kensington area — the first three in the winter of that year. Not long after those robberies — in none of which he actually had a weapon — in May 2012, he and a friend were lauded as heroes for pulling five children from a car that had been involved in a fatal accident near Kennywood Park.
“That was him,” his stepfather said of the rescue. “He did that instinctively and didn’t give it a thought.”
But ultimately, he couldn’t save himself, despite his family’s best efforts over the next four years that included treatment at recovery centers, once for two months. None of it stuck.
He served some time for the robberies but was released on probation, which he violated in 2015 and was sent back to jail, before getting out just before he began the descent that led to his overdose.
Over those years, “we went to counselors, attorneys, pastors, priest, anybody who would listen,” Anthony Donatelli said.
But McKallip “didn’t think he had a problem,” his mother said.
When the end came, after four days in the hospital, the emptiness his family felt found solace when a CORE representative met them at the hospital.
McKallip had not indicated he wanted to donate his organs. But when his parents were finally asked about, Michelle Donatelli said: “It was an immediate yes.”
“I thought (through organ donation) I’d eventually be able to meet other people we’d help,” she said, “and that part of him was still living.”