Heart Transplantation After Donation After Circulatory Death: Early United States Experience

This study examines trends and long-term survival outcomes for heart transplants involving donation after circulatory death (DCD) versus donation after brain death (DBD). Using data from December 2019 to September 2023, the study identified 792 DCD transplants out of 11,625 total heart transplants, with 249 classified as normothermic regional perfusion (DCD-NRP) and 543 classified as direct procurement and perfusion (DCD-DPP). The proportion of DCD transplants increased from 2 percent in December 2019 to 11 percent in early 2023. Survival rates at 1 and 3 years posttransplant were similar between DBD and both DCD-NRP and DCD-DPP groups. Rates of postoperative complications, including stroke, dialysis, acute graft rejection, and primary graft dysfunction, were also comparable. The study found that survival rates were consistent across different recipient risk levels and transplant center volumes. These results suggest that DCD hearts offer comparable long-term survival to DBD hearts and support the expanding use of DCD donors to increase the available organ pool.