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. 2025 Dec;170(6):1687-1696.
doi: 10.1016/j.jtcvs.2025.08.013. Epub 2025 Aug 19.

Five-year experience of heart transplantation following donation after circulatory death

Abigail R Benkert  1 , Oliver K Jawitz  2 , Alejandro Alvarez Lobo  2 , Sarah Casalinova  2 , Divyam Goel  2 , Krish C Dewan  2 , Chetan B Patel  3 , Adam D DeVore  4 , Jacob N Schroder  2 , Carmelo A Milano  2 , Jeffrey E Keenan  2
Affiliations

Five-year experience of heart transplantation following donation after circulatory death

Abigail R Benkert et al. J Thorac Cardiovasc Surg. 2025 Dec.

Abstract

Objective: The United States' experience with heart transplantation following donation after circulatory death (DCD HT) has expanded since clinical adoption in 2019. We aimed to examine a large institution's outcomes associated with DCD HT versus HT following donation after brain death (DBD).

Methods: Adult heart recipients and corresponding donors at a single quaternary academic center from January 2019 to October 2024 were included. Recipient and donor data were extracted from the institution's electronic medical record and the United Network for Organ Sharing registry, respectively. The primary outcome was overall survival.

Results: In total, 553 heart donors and recipients met inclusion criteria, including 404 (73%) DBD and 149 (27%) DCD recipients. Recipients of DCD allografts were less likely to have an intra-aortic balloon pump before transplant, but there was no significant difference in waitlist status at the time of transplant between the 2 groups. DCD allografts had increased total ischemic time (defined by United Network for Organ Sharing registry as time between donor explant and re-perfusion in the recipient) (5.7 vs 3.7 hours; P < .001) and distance to travel (381 vs 299 miles; P = .001) compared with DBD allografts. Unadjusted Kaplan-Meier survival analysis demonstrated no significant difference between DCD and DBD recipients' cumulative survival (log-rank P = .14). The rate of severe primary graft dysfunction was not significantly different between groups (12% DCD vs 11% DBD; P = .65).

Conclusions: Cardiac allografts from DCD donors perform similarly to a contemporary population of DBD allografts. The rate of severe primary graft dysfunction and the unadjusted cumulative survival were not significantly different between DCD and DBD cohorts.

Keywords: clinical outcomes; heart transplantation; heart transplantation following donation after brain death; heart transplantation following donation after circulatory death; united network for organ sharing.

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Conflict of interest statement

Conflict of Interest Statement Dr Schroder has received research funding paid to his institution from TransMedics. Dr DeVore has received research funding through his institution from Biofourmis, Bodyport, Cytokinetics, American Regent Inc, The National Heart, Lung, and Blood Institute, Novartis, and Story Health; consulting fees and/or honoraria from Bodyport, Cardionomic, LivaNova, Myovant, Natera, NovoNordisk, and Zoll; and nonfinancial support from Abbott for educational and research activities. Dr Milano has received research funding from TransMedics. Drs Schroder, DeVore, Patel, and Milano were involved in the OCS Heart EXPAND trial and the Donors After Circulatory Death Heart trial. Dr Schroder is the Principal Investigator for the PRESERVE Heart Study. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

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