Related Experiment Video
Updated: Sep 10, 2025
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Five-year experience of heart transplantation following donation after circulatory death
Abigail R Benkert1, Oliver K Jawitz1, Alejandro Alvarez Lobo1
1Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
Insights
Heart transplants using donation after circulatory death (DCD) allografts show similar survival and graft dysfunction rates compared to donation after brain death (DBD) allografts. This indicates DCD heart transplants are a viable option.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Organ Donation
Background:
- Donation after circulatory death (DCD) heart transplantation (HT) has gained traction in the US since 2019.
- Understanding outcomes of DCD HT compared to traditional donation after brain death (DBD) HT is crucial for expanding organ utilization.
Purpose of the Study:
- To compare the outcomes of heart transplantation using DCD donors versus DBD donors at a large academic institution.
- To evaluate differences in graft function and patient survival between DCD and DBD heart recipients.
Main Methods:
- A retrospective analysis of adult heart recipients and donors from January 2019 to October 2024 at a single center.
- Data extracted from electronic medical records and the United Network for Organ Sharing (UNOS) registry.
- Primary outcome was overall survival; secondary outcomes included primary graft dysfunction (PGD).
Main Results:
- 149 DCD and 404 DBD heart transplants were analyzed.
- DCD allografts experienced longer ischemic times and greater travel distances.
- No significant differences were observed in unadjusted cumulative survival or the rate of severe primary graft dysfunction between DCD and DBD groups.
Conclusions:
- Cardiac allografts from DCD donors demonstrate comparable performance to DBD allografts.
- DCD heart transplantation is a safe and effective option with similar outcomes to DBD heart transplantation.
Objective:
The United States' experience with heart transplantation following donation after circulatory death (DCD HT) has expanded since clinical adoption in 2019. We aimed to examine a large institution's outcomes associated with DCD HT versus HT following donation after brain death (DBD).
Methods:
Adult heart recipients and corresponding donors at a single quaternary academic center from January 2019 to October 2024 were included. Recipient and donor data were extracted from the institution's electronic medical record and the United Network for Organ Sharing registry, respectively. The primary outcome was overall survival.
Results:
In total, 553 heart donors and recipients met inclusion criteria, including 404 (73%) DBD and 149 (27%) DCD recipients. Recipients of DCD allografts were less likely to have an intra-aortic balloon pump before transplant, but there was no significant difference in waitlist status at the time of transplant between the 2 groups. DCD allografts had increased total ischemic time (defined by United Network for Organ Sharing registry as time between donor explant and re-perfusion in the recipient) (5.7 vs 3.7 hours; P < .001) and distance to travel (381 vs 299 miles; P = .001) compared with DBD allografts. Unadjusted Kaplan-Meier survival analysis demonstrated no significant difference between DCD and DBD recipients' cumulative survival (log-rank P = .14). The rate of severe primary graft dysfunction was not significantly different between groups (12% DCD vs 11% DBD; P = .65).
Conclusions:
Cardiac allografts from DCD donors perform similarly to a contemporary population of DBD allografts. The rate of severe primary graft dysfunction and the unadjusted cumulative survival were not significantly different between DCD and DBD cohorts.
