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Review
. 2025 Mar;13(3):389-401.
doi: 10.1016/j.jchf.2024.09.016. Epub 2024 Nov 20.

Donor Selection for Heart Transplantation in 2025

Rashmi Jain  1 , Evan P Kransdorf  2 , Jennifer Cowger  3 , Valluvan Jeevanandam  4 , Jon A Kobashigawa  1
Affiliations
Review

Donor Selection for Heart Transplantation in 2025

Rashmi Jain et al. JACC Heart Fail. 2025 Mar.

Abstract

The number of candidates on the waiting list for heart transplantation (HT) continues to far outweigh the number of available organs, and the donor heart nonuse rate in the United States remains significantly higher than that of other regions such as Europe. Although predicting outcomes in HT remains challenging, our overall understanding of the factors that play a role in post-HT outcomes continues to grow. We observe that many donor risk factors that are deemed "high-risk" do not necessarily always adversely affect post-HT outcomes, but are in fact nuanced and interact with other donor and recipient risk factors. The field of HT continues to evolve, with ongoing development of technologies for organ preservation during transport, expansion of the practice of donation after circulatory death, and proposed changes to organ allocation policy. As such, the field must continue to refine its processes for donor selection and risk prediction in HT.

Keywords: donation after circulatory death; donor selection; heart failure; heart transplantation.

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Conflict of interest statement

Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1.
Figure 1.
Numbers of patients on the United States heart transplant waiting list versus those transplanted between 2000 – 2023 (based on data made available by Organ Procurement & Transplantation Network at https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/)
Figure 2.
Figure 2.
Illustrations of (a) the direct procurement and preservation method of donation after circulatory death organ procurement and (b) the normothermic regional perfusion process
Figure 3.
Figure 3.. Donor risk evaluation algorithm
CAD = coronary artery disease; LV = left ventricular; PHM = predicted heart mass
Central Illustration.
Central Illustration.
Components of decision making in donor selection for heart transplantation CAD = coronary artery disease, DBD = donation after brain death, DCD = donation after circulatory death, EF = ejection fraction, LVH = left ventricular hypertrophy, MCS = mechanical circulatory support, NRP = normothermic regional perfusion
See this image and copyright information in PMC

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