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Updated: Jul 9, 2026
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Heart Transplantation After Donation After Circulatory Death: Early United States Experience
Syed Shahyan Bakhtiyar1, Sara Sakowitz2, Saad Mallick2
1Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, California; Department of Surgery, University of Colorado, Aurora, Colorado.
Insights
Heart transplants using donation after circulatory death (DCD) donors are increasing. DCD heart transplants show survival rates comparable to donation after brain death (DBD) up to three years, supporting expanded donor use.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donation
Background:
- Renewed interest in heart transplantation utilizing donation after circulatory death (DCD) donors.
- Need for contemporary analysis of trends and long-term survival in DCD heart transplantation.
Purpose of the Study:
- To analyze trends in DCD heart transplantation.
- To compare posttransplant survival rates between donation after brain death (DBD) and DCD heart recipients.
Main Methods:
- Adult heart transplant recipients from December 2019 to September 2023 identified in the Organ Procurement and Transplantation Network.
- Stratification of recipients into DBD or DCD groups, with DCD further classified into direct procurement and perfusion (DCD-DPP) or normothermic regional perfusion (DCD-NRP).
- Primary outcome was 1- and 3-year posttransplant survival.
Main Results:
- 7% (792 of 11,625) of heart transplants involved DCD allografts, with a significant increase in DCD use from 2% to 11% between December 2019 and September 2023.
- Adjusted analysis revealed similar 1-year and 3-year posttransplant survival for DBD recipients compared to both DCD-DPP and DCD-NRP recipients.
- Incidence of postoperative stroke, dialysis, acute graft rejection, and primary graft dysfunction were comparable across all groups.
Conclusions:
- The utilization of DCD heart transplantation is rising.
- DCD and DBD heart recipients demonstrate equivalent posttransplant survival up to three years across diverse recipient risk and center volume categories.
- These findings support the expanded use of DCD donors to increase the available organ pool for heart transplantation.
Background:
Given the renewed interest in heart transplantation after donation after circulatory death (DCD), a contemporary analysis of trends and longer-term survival is warranted.
Methods:
Adult heart transplant recipients (December 2019-September 2023) were identified in the Organ Procurement and Transplantation Network. Recipients were stratified as donation after brain death (DBD) or DCD. DCD procurements were further classified as direct procurement and perfusion (DCD-DPP) or normothermic regional perfusion (DCD-NRP), based on the declaration of death to cross-clamp interval (≥40 minutes DCD-NRP). The main outcome was posttransplant survival at 1 and 3 years.
Results:
Of 11,625 transplantations, 792 (7%) involved DCD allografts (249 DCD-NRP, 543 DCD-DPP). The proportion of transplants involving DCD allografts significantly increased from 2% (December 2019) to 11% (January-September 2023, P < .001). Upon adjusted analysis, 1-year posttransplant survival was similar for DBD vs DCD-DPP (hazard ratio [HR], 1.00; 95% CI, 0.66-1.66) or DCD-NRP (HR, 0.92; 95% CI, 0.49-1.72). This remained true at 3 years for DCD-DPP (HR, 1.07; 95% CI, 0.77-1.48) and DCD-NRP (HR, 1.04; 95% CI, 0.62-1.73). Incidence of postoperative stroke, dialysis, acute graft rejection, and primary graft dysfunction were similar across groups. Across various strata of recipient risk and center volume, survival was equivalent between the DBD and DCD cohorts.
Conclusions:
Rates of DCD heart transplantation continue to rise. Across various recipient risk and center volume categories, DCD and DBD recipients show comparable posttransplant survival up to 3 years. These findings encourage broader use of such donors in attempts to expand the organ pool.
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