Related Experiment Video
Updated: Jul 15, 2025
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Outcomes of Heart Transplant Donation After Circulatory Death
Hasan K Siddiqi1, John Trahanas2, Meng Xu3
1Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Insights
Heart transplants using donation after circulatory death (DCD) hearts show outcomes noninferior to donation after brain death (DBD) hearts. This supports DCD donors as a safe option to expand the heart donor pool.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Donation after circulatory death (DCD) heart transplantation is growing, increasing donor availability and reducing wait times.
- Limited clinical outcome data exists for DCD heart transplants.
Purpose of the Study:
- To compare 6-month and 1-year clinical outcomes of DCD heart recipients with donation after brain death (DBD) heart recipients.
- To evaluate the efficacy of normothermic regional perfusion (NRP) in DCD heart recovery.
Main Methods:
- Retrospective observational study of adult heart-only transplants (January 2020 - January 2023).
- Comparison of outcomes between DCD and DBD heart recipients using survival analysis and Cox regression.
Main Results:
- 122 of 385 heart transplants (32%) used DCD donors, 83% recovered with NRP.
- DCD donors were younger with fewer comorbidities; DCD recipients had fewer pre-transplant hospitalizations and less need for mechanical support.
- No significant differences in 1-year survival, graft dysfunction, rejection, or cardiac allograft vasculopathy between DCD and DBD recipients.
Conclusions:
- Outcomes for DCD heart recipients are noninferior to DBD recipients.
- This study supports the use of DCD donors as a safe method to expand the heart donor pool.
Background:
Heart transplantation using donation after circulatory death (DCD) allografts is increasingly common, expanding the donor pool and reducing transplant wait times. However, data remain limited on clinical outcomes.
Objectives:
We sought to compare 6-month and 1-year clinical outcomes between recipients of DCD hearts, most of them recovered with the use of normothermic regional perfusion (NRP), and recipients of donation after brain death (DBD) hearts.
Methods:
We conducted a single-center retrospective observational study of all adult heart-only transplants from January 2020 to January 2023. Recipient and donor data were abstracted from medical records and the United Network for Organ Sharing registry, respectively. Survival analysis and Cox regression were used to compare the groups.
Results:
During the study period, 385 adults (median age 57.4 years [IQR: 48.0-63.7 years]) underwent heart-only transplantation, including 122 (32%) from DCD donors, 83% of which were recovered with the use of NRP. DCD donors were younger and had fewer comorbidities than DBD donors. DCD recipients were less often hospitalized before transplantation and less likely to require pretransplantation temporary mechanical circulatory support compared with DBD recipients. There were no significant differences between groups in 1-year survival, incidence of severe primary graft dysfunction, treated rejection during the first year, or likelihood of cardiac allograft vasculopathy at 1 year after transplantation.
Conclusions:
In the largest single-center comparison of DCD and DBD heart transplantations to date, outcomes among DCD recipients are noninferior to those of DBD recipients. This study adds to the published data supporting DCD donors as a safe means to expand the heart donor pool.
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