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Updated: Jan 27, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Outcomes of Donation After Circulatory Death Heart Transplantation in Australia
Hong Chee Chew1, Arjun Iyer2, Mark Connellan2
1St. Vincent's Hospital, Sydney, New South Wales, Australia; Cardiac Transplant Laboratory, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; St. Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
Insights
Donation after circulatory death (DCD) heart transplants show excellent outcomes, comparable to brain-dead donors. This Australian program highlights successful distant procurement and transplantation, with high survival rates and normal cardiac function in recipients.
Area of Science:
- Cardiology
- Transplant Surgery
- Organ Donation
Background:
- Donation after circulatory death (DCD) heart transplantation is an advancing clinical field.
- The study provides an update on an Australian DCD heart transplant program.
- It reviews lessons learned from performing the world's first series of distantly procured DCD heart transplants.
Purpose of the Study:
- To update on the Australian clinical program for DCD heart transplantation.
- To discuss challenges and lessons learned from distant DCD heart procurement and transplantation.
Main Methods:
- Retrospective analysis of 23 DCD heart transplants performed between July 2014 and April 2018.
- Data collected from electronic donor records and hospital clinical notes.
- Assessment of donor viability using normothermic machine perfusion.
Main Results:
- 23 DCD hearts were successfully transplanted out of 45 referrals.
- Successful implantation in all recipients; 9 required mechanical circulatory support.
- 4.4% mortality rate over 4 years; surviving recipients showed normal cardiac function and no acute rejection.
Conclusions:
- DCD heart transplantation demonstrates excellent clinical outcomes.
- Survival and rejection rates are comparable to contemporary brain-dead donor heart transplants.
- Mechanical circulatory support is often needed for delayed graft function, particularly in VAD recipients.
Background:
Transplantation of hearts retrieved from donation after circulatory death (DCD) donors is an evolving clinical practice.
Objectives:
The purpose of this study is to provide an update on the authors' Australian clinical program and discuss lessons learned since performing the world's first series of distantly procured DCD heart transplants.
Methods:
The authors report their experience of 23 DCD heart transplants from 45 DCD donor referrals since 2014. Donor details were collected using electronic donor records (Donate Life, Australia) and all recipient details were collected from clinical notes and electronic databases at St. Vincent's Hospital.
Results:
Hearts were retrieved from 33 of 45 DCD donors. A total of 12 donors did not progress to circulatory arrest within the pre-specified timeframe. Eight hearts failed to meet viability criteria during normothermic machine perfusion, and 2 hearts were declined due to machine malfunction. A total of 23 hearts were transplanted between July 2014 and April 2018. All recipients had successful implantation, with mechanical circulatory support utilized in 9 cases. One case requiring extracorporeal membrane oxygenation subsequently died on the sixth post-operative day, representing a mortality of 4.4% over 4 years with a total follow-up period of 15,500 days for the entire cohort. All surviving recipients had normal cardiac function on echocardiogram and no evidence of acute rejection on discharge. All surviving patients remain in New York Heart Association functional class I with normal biventricular function.
Conclusions:
DCD heart transplant outcomes are excellent. Despite a higher requirement for mechanical circulatory support for delayed graft function, primarily in recipients with ventricular assist device support, overall survival and rejection episodes are comparable to outcomes from contemporary brain-dead donors.
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