Lori Blankenship knows her son made bad decisions. But just weeks after his fatal drug overdose about a month ago, she was reminded of a good choice he made.
He had registered as an organ donor.
Luis Burks' kidneys and liver went to three people, and his lungs were given to research, putting him in a donor category that is growing faster than any other.
One in 11 deceased organ donors across the country last year had a history of injecting drugs and died of a drug overdose, a rate that has more than tripled in less than a decade. It's closer to one in six in Maryland.
That means Maryland has "one of the highest rates in the country," said Charles Alexander, president and CEO of the Living Legacy Foundation, which coordinates organ donations across much of the state. "It's sadly reflective of the epidemic."
Overdose deaths, largely from heroin and powerful prescription painkillers such as fentanyl, have reached record highs across the country. Maryland had one of the biggest surges in the country, with 1,259 fatal overdoses last year, twice the number in 2010.
Nationally, organ donations from those who overdosed from injected drugs are the fourth-largest donor group, according to data from the United Network for Organ Sharing, which coordinates donations. Drug overdoses eclipsed homicide victims years ago.
Drug overdoses rank behind people who died of natural causes — the largest group of donors — as well as car crash victims and those who committed suicide. Car crash donors have declined as auto safety improved.
Blankenship said being able to save someone else's life provides families a silver lining to their tragedies. Living Legacy's Alexander said three-quarters of families asked to donate a loved one's organs do so.
Often Living Legacy doesn't have to ask because drug users register to be organ donors at a higher rate than other types of donors, he said. About 70 percent of the donors who fatally overdosed in Maryland had registered themselves, compared with about 50 percent of all donors overall.
Dr. Dorry Segev, a Johns Hopkins Hospital transplant surgeon, said people ages 18 to 34 have been particularly hard hit by the drug epidemic, and young adults are internet-savvy and more likely to go online and register, he said.
Spurred by another Hopkins surgeon in 2012, the popular social media site Facebook began allowing users to share their donor status with special status buttons and to link to state department of motor vehicle websites to register, a move that boosted signups 21-fold in one day.
The organs from drug overdoses have helped to meet demand in a donor system that doesn't have enough supply, said Segev, an associate professor of surgery and epidemiology at the Johns Hopkins School of Medicine.
The organs also tend to be healthier and more durable than those of older donors, which frequently show signs of age and disease.
Doctors are often more concerned about the lifestyle of a drug user. The federal government labels them "infectious risk donors" because they are more likely to be infected with HIV or hepatitis. Screening organs for disease has vastly improved in recent years, but there's still a slight risk that infections could go undetected.
Segev said in almost all cases the risk of infection for a recipient is far lower than the risk of death. For instance, the risk is lower than staying on dialysis for someone with malfunctioning kidneys, the most in-demand organs.
"The take-home message from the patient standpoint is the risk of unintended transmission of disease is exceedingly low and the benefits these organs bring are very high," he said.
At Hopkins, doctors increasingly rely on this pool of donors. Up to 40 percent of the transplants from deceased donors now comes from infectious-risk donors, likely the highest rate of any hospital in the nation, said Segev, who also pioneered HIV-positive organ donation to HIV-positive recipients.
No transplant patient at Hopkins has been infected with diseases from donated organs.
Still, not everyone wants an organ from a drug user, or from a prostitute, prisoner or even promiscuous college student, also considered risks, said Dr. Jonathan S. Bromberg, a transplant surgeon at the University of Maryland Medical Center. Donors or their family members must answer detailed questions about the donor's history.
"I have the conversation a lot, every day," said Bromberg, a professor of surgery and division head of transplant surgery at University of Maryland School of Medicine. "Some still say no. But somebody says yes somewhere. Those who are much sicker often can appreciate the organ."
Nationally, 22 people a day die waiting for an organ. There are more than 120,000 people on the national waiting list.
In Maryland, there are more than 3,800 on waiting lists at transplant centers. Living Legacy estimates that 400 or more organs will be transplanted this year, from 150 to 160 donors.
While an increasing number of organs come from live donors, only about 2 to 3 percent of people who die qualify to give organs because the donors must be declared brain dead in the hospital where they can remain on life support.
Luis Burks was clinging to life in mid-July in a bathroom in his mother's Rosedale house. His uncle, who grew suspicious because the door was closed for so long, found Burks and tried to revive him before calling 911.
It was two days before doctors at MedStar Franklin Square Medical Center told Blankenship that her son would not recover and Living Legacy representatives informed her about his donor registration.
There's a chance, she said, Burks decided to register because Blankenship told him that she had, or because the volunteer work they'd done together had made an impression on him. For a time before addiction wrecked his work ethic, Burks was employed with his mother in a warehouse for the retail giant Kohl's, and the pair often participated in volunteer events sponsored by the company.
She said he'd be proud that he helped others with his organs. Even more may benefit from research on his lungs, including one of his sisters who has asthma.
"He was always the one telling people they would be fine," even though he was struggling with depression, Blankenship said. He may have been self-medicating when he began abusing prescription painkillers, she said.
He began sleeping a lot, and she began finding needle caps in the bathroom they shared. But she didn't "connect the dots" that he'd moved on to injecting drugs, probably heroin.
Four days after Burk's overdose, his organs were removed.
The time gave family and friends a chance to say their goodbyes. Blankenship found herself having to assure some family and friends that brain dead really meant he was dead, despite the machines that kept oxygen and blood moving through his body.
Blankenship said she's since made some of her own decisions: She'll try to get help for those she suspects are abusing or addicted to drugs, and she will get training on how to use the overdose antidote naloxone. She'll be more sympathetic to those who may be suffering. She will speak out about addiction and organ donation, and their grim intersection.
She'll make sure Burks' 5-year-old daughter knows that his donations helped save lives.
"This is taking a bad thing and making it good," she said.