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Updated: Jan 17, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Simultaneous Heart and Kidney Transplantation Using Circulatory Death Donors: Are Kidney Graft Outcomes Comparable
Sooyun Caroline Tavolacci1,2,3, Kenji Okumura4, Ameesh Isath5
1Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY.
Insights
Simultaneous heart and kidney transplants (SHKTs) using donation after circulatory death (DCD) donors show outcomes comparable to those from donation after brain death (DBD) donors. This suggests DCD donors are a viable option for SHKTs, especially for patients with kidney issues.
Area of Science:
- Transplantation immunology
- Cardiovascular surgery
- Nephrology
Background:
- Limited evidence exists for heart and kidney transplants from donation after circulatory death (DCD) donors.
- Outcomes of simultaneous heart and kidney transplants (SHKTs) using DCD donors compared to donation after brain death (DBD) donors are not well understood.
Purpose of the Study:
- To compare graft outcomes and survival rates of SHKTs performed using DCD versus DBD donors.
- To evaluate the viability of DCD donors for SHKTs.
Main Methods:
- Analysis of the United Network for Organ Sharing database for adult SHKTs from May 2020 to September 2023.
- Comparison of 91 DCD-SHKT cases with 273 propensity score-matched DBD-SHKT cases.
- Multivariate Cox proportional hazards analysis to assess mortality risk.
Main Results:
- Recipient and graft survival rates were comparable between DCD and DBD donor groups in the matched cohort.
- Delayed graft function in kidneys was similar between DCD and DBD recipients.
- Donor type (DCD) was not significantly associated with increased mortality risk.
Conclusions:
- SHKTs using DCD donors demonstrate comparable survival and graft outcomes to those using DBD donors.
- DCD donors represent a valuable option for SHKTs, potentially aiding donor selection for heart transplant candidates with renal impairment.
Background:
There is limited evidence on heart and kidney transplants using donation after circulatory death (DCD) donors, especially regarding graft outcomes. However, little is known about the use of DCD donors for simultaneous heart and kidney transplants (SHKTs) compared with SHKTs using donation after brain death (DBD) donors.
Methods:
From May 22, 2020, to September 30, 2023, 1129 adult patients received SHKTs (DCD, N = 91 versus DBD, N = 1038), identified using the United Network for Organ Sharing database, excluding other multiorgan transplants and retransplants. A propensity score matching was performed using characteristics. Ninety-one DCD- and 273 DBD-matched cases were compared.
Results:
In the unmatched cohort, DCD recipients were older (DCD: 60 versus DBD: 58 y, P = 0.03), had a lower rate of dialysis at transplant (27% versus 40%, P = 0.03), and were of status 1 to 2 (43% versus 72%, P < 0.001). In the matched cohort, kidney delayed graft function (27% versus 22%, P = 0.29) was comparable, as were recipient survival (P = 0.19), heart graft survival (P = 0.19), and kidney graft survival (P = 0.17). In multivariate Cox proportional hazards analysis, donor type (DCD) was not associated with an increased risk of mortality (hazard ratio, 1.69; 95% confidence interval, 0.90-3.16; P = 0.10). Subgroup analysis showed that survival and freedom from graft failures were comparable between different modes of DCD recovery.
Conclusions:
SHKT using DCD donors yields comparable survival and graft outcomes to those using DBD donors. These findings may help donor selection in heart transplant candidates with kidney dysfunction.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure