Related Experiment Video
Updated: Apr 20, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
A comparison of DCD heart transplantation in Europe and the United States: A multi-center, retrospective study
John O Louca1, Marco Öchsner2, Ashish Shah3
1Cambridge Stem Cell Institute, University of Cambridge, Cambridge, United Kingdom; Royal Papworth Hospital, Cambridge, United Kingdom,; John Radcliffe Hospital, Oxford, United Kingdom.
Insights
Donation after circulatory determination of death (DCD) heart transplantation (HT) is safe and effective in the US and Europe. Differences in donor/recipient factors exist, but international data collection can refine DCD HT outcomes.
Area of Science:
- Cardiology
- Transplant Surgery
- Organ Donation
Background:
- Donation after circulatory determination of death (DCD) heart transplantation (HT) is increasingly adopted in the US and Europe.
- This study analyzes outcomes from DCD HT centers across these regions.
Purpose of the Study:
- To compare donor and recipient demographics, intraoperative parameters, and outcomes between DCD HT centers in Europe and the US.
- To evaluate the safety and efficacy of DCD HT internationally.
Main Methods:
- Retrospective observational study across 22 HT centers in Belgium, Spain, UK, and US.
- Included patients undergoing DCD HT from program inception through January 1, 2023 (follow-up to January 1, 2024).
- Primary outcome: 1-year survival; Secondary outcomes: severe primary graft dysfunction, acute cellular rejection.
Main Results:
- Analyzed data from 223 European and 281 US patients.
- European DCD donors were older (37 vs. 28 years).
- European recipients had lower 1-year survival (86.6% vs. 91.8%), with similar 1-month and 3-year survival.
- Direct procurement and preservation (DPP) showed higher 1-year survival in the US (91.2% vs. 82.6%).
- Thoraco-abdominal normothermic regional perfusion (taNRP) showed similar 1-year survival between regions.
- European recipients had higher post-transplant mechanical circulatory support use (17.9% vs. 11%).
Conclusions:
- DCD HT is safe and effective across US and European centers, despite demographic and outcome variations.
- International data collection is crucial for identifying strategies to improve DCD HT outcomes.
- Further research can optimize DCD heart transplantation protocols globally.
Background:
Donation after the circulatory determination of death (DCD) heart transplantation (HT) is becoming more widely adopted across the United States (US) and Europe.
Objective:
This study compared donor and recipient demographics, intraoperative parameters, and outcomes between DCD HT centers in Europe and the US that contributed to the Outcomes after DCD Cardiac Transplantation Database.
Methods:
This was a retrospective observational study across 22 HT centers in Belgium, Spain, the United Kingdom (UK), and the US. All patients undergoing DCD HT at participating centers, from the start of each center's DCD program through 01/01/2023, were included with censor date 01/01/2024. The primary outcome was 1-year survival. Secondary outcomes included severe primary graft dysfunction and incidence of acute cellular rejection.
Results:
Data from 223 patients in Europe and 281 in the US were analyzed. DCD donors in Europe were significantly older (37 years vs 28 years; p < 0.001). Recipients in Europe had inferior 1-year survival (86.6% vs 91.8%; p = 0.043), but 1-month and 3-years survival were similar. 1-year survival in the direct procurement and preservation (DPP) cohort was significantly higher in the US group (91.2% vs 82.6%; p = 0.02). In the thoraco-abdominal normothermic regional perfusion (taNRP) cohort 1-year survival was similar between Europe and the US. Recipients in Europe had higher use of mechanical circulatory assist post-transplant (17.9% vs 11%; p = 0.03).
Conclusion:
This study further confirms the safety and efficacy of DCD HT across centers in the US and Europe, despite important differences in donor and recipient demographics and clinical outcomes. Continued collection of international data may identify opportunities to improve outcomes.
Related Concept Videos
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:29Cardiomyopathy V: Interprofessional Care