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Updated: Jan 13, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Donation After Circulatory Death Donors for Heart Transplantation: Does Center Volume Matter?
Doug A Gouchoe1, Shane S Scott2, Divyaam Satija1
1Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Insights
Center volume does not impact outcomes for donation after circulatory death (DCD) heart transplants. While low-volume centers have longer wait times, survival rates are similar across high and low-volume centers for DCD heart transplantation.
Area of Science:
- Cardiology
- Transplant Surgery
- Organ Donation
Background:
- Donation after circulatory death (DCD) is an emerging strategy for heart transplantation.
- Understanding the impact of transplant center volume on DCD heart transplant outcomes is crucial.
Purpose of the Study:
- To evaluate whether heart transplant center volume (high vs. low) affects perioperative outcomes and short-term survival in DCD donors.
- To identify disparities in waitlist times and medical urgency between high- and low-volume centers.
Main Methods:
- Utilized the United Network for Organ Sharing registry (2019-2025) for DCD heart recipients.
- Stratified centers into high-volume (>15 transplants) and low-volume (≤15 transplants) based on 2019-2020 data.
- Employed comparative statistics, Kaplan-Meier survival analysis, and Cox regression to assess center volume's association with mortality.
Main Results:
- Low-volume centers had longer waitlist times and higher rates of temporary mechanical circulatory support use.
- High-volume centers granted significantly more exceptions per center.
- No significant differences were observed in perioperative outcomes or short-term survival between high- and low-volume centers.
Conclusions:
- Transplant center volume does not significantly influence perioperative outcomes or survival following DCD heart transplantation.
- Discrepancies in waitlist times and medical urgency highlight potential inequities in the allocation system.
- Further improvements in organ allocation are needed to ensure equitable access to heart transplantation for all recipients.
Purpose:
Donation after circulatory death (DCD) as a donor for heart transplantation is a new practice. We sought to determine if center volume (high vs low) influenced perioperative outcomes and short-term survival.
Methods:
The United Network for Organ Sharing registry was used to identify DCD heart recipients from 2019 to 2025. Recipients were stratified based on center volume: high-volume (>15 transplants over the observational period from 2019 to 2020) or low volume (≤15 transplants). Comparative statistics and Kaplan-Meier methods with the log-rank test were used to compare groups and determine survival. A Cox regression analysis using select donor and recipient criteria was created to determine the association of center volume and mortality.
Results:
Low-volume group recipients had significantly longer waitlist times, temporary mechanical circulatory support use, and were more likely to be status 1 or 2 compared to the high-volume group. However, high-volume centers had significantly higher exceptions granted per center compared to low-volume centers. There were no significant differences in perioperative outcomes or short-term survival. Following adjustment, center volume was not independently associated with increased mortality, while increasing ischemic time was.
Conclusions:
Transplant center volume had no significant effect on perioperative outcomes or survival after DCD heart transplantation. The discrepancy in presumed medical urgency and increased waitlist time in the low-volume cohort is highlighted by significantly more exceptions granted to high-volume recipients. This should be a noted area for improvement in the new allocation system to make heart transplantation more equitable for all recipients.
