Related Experiment Video
Updated: Aug 26, 2025
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Early Outcomes of Heart Transplantation Using Donation After Circulatory Death Donors in the United States
Jennie H Kwon1, Alexander D Ghannam1, Khaled Shorbaji1
1Division of Cardiothoracic Surgery, Department of Surgery (J.H.K., A.D.G., K.S., B.W., Z.A.H., A.K.), Medical University of South Carolina, Charleston.
Insights
Heart transplantation using donation after circulatory death (DCD) is increasing in the US. Outcomes are comparable to donation after brain death, indicating DCD heart transplants are safe and feasible.
Area of Science:
- Cardiology
- Transplantation Surgery
- Organ Donation
Background:
- Limited donor availability drives interest in heart transplantation (HT) using donation after circulatory death (DCD).
- Procurement techniques have evolved, making DCD HT a viable option.
- Evaluating DCD HT outcomes in the US is crucial.
Purpose of the Study:
- To assess the outcomes of heart transplantation utilizing donors after circulatory death.
- To compare DCD heart transplantation with donation after brain death in the US.
Main Methods:
- Analysis of the United Network for Organ Sharing registry (2019-2021).
- Stratification of recipients into DCD and donation after brain death groups.
- Propensity-score matching and Cox proportional hazards modeling for 1-year mortality prediction.
Main Results:
- DCD heart transplantation frequency rose from 0.2% to 6.4% between 2019 and 2021.
- 1-year survival rates were comparable: 92.5% for DCD vs. 90.3% for donation after brain death.
- Increasing recipient age and waitlist time were predictors of mortality in DCD HT.
Conclusions:
- DCD heart transplantation rates are rising in the United States.
- DCD HT demonstrates comparable safety and feasibility to donation after brain death.
- US DCD HT outcomes align with international data, supporting wider adoption.
Background:
Limited donor availability and evolution in procurement techniques have renewed interest in heart transplantation (HT) with donation after circulatory death (DCD). The aim of this study is to evaluate outcomes of HT using DCD in the United States.
Methods:
The United Network for Organ Sharing registry was used to identify adult HT recipients from 2019 to 2021. Recipients were stratified between DCD and donation after brain death. Propensity-score matching was performed. Cox proportional hazards was used to identify independent predictors of 1-year mortality. Kaplan-Meier analysis was used to estimate 1-year survival.
Results:
Of 7496 HTs, 229 DCD and 7267 donation after brain death recipients were analyzed. The frequency of DCD HT increased from 0.2% of all HT in 2019 to 6.4% in 2021 (P<0.001), and the number of centers performing DCD HT increased from 3 of 120 centers to 20 of 121 centers (P<0.001). DCD donors were more likely to be younger, male, and White. After propensity matching, 1-year survival was 92.5% for DCD versus 90.3% for donation after brain death (hazard ratio, 0.80 [95% CI, 0.44-1.43]; P=0.44). Among DCD HTs, increasing recipient age and waitlist time predicted 1-year mortality on univariable analysis.
Conclusions:
Rates of DCD HT in the United States are increasing. This practice appears safe and feasible as mortality outcomes are comparable to donation after brain death. Although this study represents early adopting centers, outcomes of the experience for DCD HT in the United States is consistent with existing international data and encourages broader utilization of this practice.
