The Fentanyl Shock

synthetic opioids and the supply of organ donors

Abstract

We study how the diffusion of illicit synthetic opioids affected the supply of deceased organ donors in the United States after 2012. As fentanyl spread rapidly from east to west, it produced sharp, uneven increases in overdose mortality across states. We first study the arrival of fentanyl as a dichotomous shock in a difference-in-differences framework at the organ procurement organization (OPO) level, contrasting regions east and west of the Mississippi River due to drug-market segmentation. We then turn to the intensive margin using a state-level IV approach that leverages the westward diffusion of fentanyl over time, with exposure measured using fentanyl mortality. Both approaches show that fentanyl exposure caused large increases in overdose-driven donor supply and transplanted organs, revealing how a lethal epidemic reshaped the availability of transplantable organs.