Related Experiment Video
Updated: Oct 3, 2025
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Appraisal of Donation After Circulatory Death: How Far Could We Expand the Heart Donor Pool?
Alejandro Suarez-Pierre1, John Iguidbashian1, Christina Stuart1
1Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
Insights
Widespread adoption of organ donation after circulatory death (DCD) hearts could significantly expand the donor pool. This could lead to approximately 580 additional heart transplants annually in the U.S.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donation
Background:
- Organ donation after circulatory death (DCD) is increasing, but heart utilization lags behind other organs.
- Ex vivo perfusion devices are under FDA review for DCD heart recovery, prompting investigation into donor pool expansion.
- The study assesses the potential impact of DCD heart donation on increasing donor availability.
Purpose of the Study:
- To quantify the potential increase in the donor pool for heart transplantation with the adoption of DCD donation.
- To evaluate the feasibility and impact of using hearts from DCD donors.
- To project the number of additional heart transplants possible through DCD donation.
Main Methods:
- Utilized data from the Organ Procurement and Transplantation Network database (2015-2020).
- Included DCD donors aged 18-49 meeting Maastricht III criteria with warm ischemia time ≤30 minutes.
- Excluded donors with specific cardiac conditions, infections, or elevated pulmonary capillary wedge pressure.
Main Results:
- Out of 12,813 DCD donors, 3,528 met criteria, with 70 hearts (2%) transplanted.
- Widespread DCD heart use could add ~48 transplants/month, a 21% national increase.
- Median warm ischemia time was 23 minutes, with no significant difference between transplanted and non-transplanted hearts.
Conclusions:
- Widespread adoption of DCD heart transplantation can substantially increase the donor pool.
- This could result in approximately 580 additional organs available annually nationwide.
- Represents a significant expansion in the donor pool for heart transplantation in the modern era.
Background:
the incidence of organ donation after circulatory death (DCD) is increasing; however, heart use has lagged behind other solid organs. Ex vivo perfusion devices are under United States Food and Drug Administration review for use in DCD heart recovery. This study sought to measure the potential increase in the donor pool if DCD heart donation becomes widely adopted.
Methods:
DCD donor data were obtained from Organ Procurement and Transplantation Network database. Selection criteria included donor age 18 to 49 years, donors meeting Maastricht III criteria, warm ischemia time ≤30 minutes, and donation between 2015 and 2020. Exclusion criteria were coronary disease, prior myocardial infarction, ejection fraction <0.50, significant valve disease, bacteremia, pulmonary capillary wedge pressure >15 mm Hg, and history of HIV/hepatitis C virus infections.
Results:
There were 12 813 DCD donors during this period, of which 3528 met study criteria, and 70 hearts (2%) were transplanted. The use of DCD hearts would represent an additional 48 heart transplants per month, which corresponds to a 21% (3458 of 16 521) increase across the country. Median warm ischemia was 23 minutes, with no difference between hearts that were or were not transplanted (23 vs 22.5 minutes, P = .97). The frequency with which other organs were successfully transplanted was kidney, 92%; liver, 44%; lung, 7%; intestine, 0%; and pancreas, 2%.
Conclusions:
Wide adoption of DCD heart transplantation could yield a substantial increase in the donor pool size, with approximately 580 additional organs being available each year across the United States. This would represent the largest increase in the donor pool in the modern era of heart transplantation.
