Related Experiment Video
Updated: Aug 30, 2025
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Heart transplantation using donation after circulatory death in the United States
Qiudong Chen1, Dominic Emerson1, Dominick Megna1
1Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif.
Insights
Heart donation after circulatory death (DCD) transplants are comparable in survival to donation after brain death (DBD) transplants. Increased use of DCD hearts could significantly boost the availability of donor organs for transplantation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donation
Background:
- Heart donation after circulatory death (DCD) was reintroduced in the US to address donor heart shortages.
- The study examines the national utilization and outcomes of DCD heart transplants.
Purpose of the Study:
- To evaluate the national use and outcomes of heart transplantation using DCD donors.
- To compare DCD heart transplants with those from donation after brain death (DBD) donors.
Main Methods:
- Utilized the United Network for Organ Sharing database for adult heart transplant data (December 2019-December 2021).
- Included 266 DCD donor transplants and 5,998 DBD donor transplants, excluding heart-lung transplants.
- Employed propensity score matching to create comparable groups for analysis.
Main Results:
- DCD heart transplants increased from 2.5% to 6.8% nationally between December 2019 and December 2021.
- DCD recipients were more likely to be clinically stable, have type O blood, and have longer wait times.
- Six-month survival was comparable between DCD (92.6%) and DBD (92.1%) heart transplants; however, DCD had higher rates of treated acute rejection before discharge (14.4% vs 8.8%).
Conclusions:
- Heart transplantation using DCD donors demonstrates short-term survival comparable to DBD transplants.
- Wider adoption of DCD heart donation can substantially increase the availability of donor organs.
Objectives:
Heart donation after circulatory death was recently reintroduced in the United States with hopes of increasing donor heart availability. We examined its national use and outcomes.
Methods:
The United Network for Organ Sharing database was used to identify validated adult patients undergoing heart transplantation using donation after circulatory death donors (n = 266) and donation after brain death donors (n = 5998) between December 1, 2019, and December 31, 2021, after excluding heart-lung transplants. Propensity score matching was used to create more balanced groups for comparison.
Results:
The monthly percentage of donation after circulatory death heart transplant increased from 2.5% in December 2019 to 6.8% in December 2021 (P < .001). Twenty-two centers performed donation after circulatory death heart transplants, ranging from 1 to 75 transplants per center. Four centers performed 70% of the national volume. Recipients of donation after circulatory death hearts were more likely to be clinically stable (80.4% vs 41.1% in status 3-6, P < .001), to have type O blood (58.3% vs 39.9%, P < .001), and to wait longer after listing (55, interquartile range, 15-180 days vs 32, interquartile range, 9-160 days, P = .003). Six-month survival was 92.1% (95% confidence interval, 91.3-92.8) after donation after brain death heart transplants and 92.6% (95% confidence interval, 88.1-95.4) after donation after circulatory death heart transplants (hazard ratio, 0.94, 95% confidence interval, 0.57-1.54, P = .79). Outcomes in propensity-matched patients were similar except for higher rates of treated acute rejection in donation after circulatory death transplants before discharge (14.4% vs 8.8%, P = .01). In donation after circulatory death heart recipients, outcomes did not differ based on the procurement technique (normothermic regional perfusion vs direct procurement and perfusion).
Conclusions:
Heart transplantation with donation after circulatory death donors has short-term survival comparable to donation after brain death transplants. Broader implementation could substantially increase donor organ availability.
