DCD Heart Transplants Show Comparable 5-Year Survival, Finds Study
USA: A U.S. national registry study has found that heart transplants using donation after circulatory death (DCD) donors had comparable short-term and 5-year mortality to transplants using donation after brain death. Although severe primary graft dysfunction was more common with DCD hearts, advances in ex situ and in situ perfusion may help mitigate this risk. The findings, published in The Annals of Thoracic Surgery, suggest DCD donation could expand the heart donor pool without compromising long-term survival.
Heart transplantation remains limited by the availability of suitable donor organs, making alternative approaches to organ donation increasingly important. Donation after circulatory death has gained momentum in the United States, but uncertainty has remained regarding its longer-term outcomes compared with conventional donation after brain death (DBD). Peter D. Cho, BS, of Drexel University College of Medicine, Philadelphia, and colleagues assessed national transplant data to examine survival following DCD heart transplantation.
The researchers analyzed data from the United Network for Organ Sharing database, including adults who underwent heart transplantation between December 2019 and December 2025. Recipients were categorized according to whether their donor heart came from a DCD or DBD donor. Baseline characteristics, perioperative outcomes, and mortality were compared between the groups. Severe primary graft dysfunction (PGD) data were available for transplants performed from September 2023 through December 2025, while Kaplan-Meier analysis was used to assess survival through 5 years.
During the study period, 19,432 adult heart transplants were performed. Of these, 2,588 procedures (13.3%) involved DCD donor hearts.
The findings showed:
- DCD heart recipients were less likely to require extracorporeal membrane oxygenation before transplantation than DBD recipients (3.9% versus 8.1%).
- DCD donors were slightly younger, with a median age of 33 years compared with 34 years among DBD donors.
- Severe PGD occurred more frequently following DCD transplantation, affecting 10.3% of recipients compared with 5.3% of those receiving DBD hearts.
- Thirty-day mortality was similar between the groups, at 2.8% with DCD hearts and 2.7% with DBD hearts.
- Five-year survival was also comparable, reaching 77.3% among DCD recipients versus 78.3% among DBD recipients.
Severe PGD was more frequent with DCD hearts, but early and 5-year mortality remained comparable with DBD transplantation. Advances in organ preservation and perfusion may further improve DCD heart outcomes.
The study was limited by its retrospective registry-based design, restricted PGD data availability, and potential differences in donor and recipient characteristics.
The authors concluded that DCD heart transplantation offers comparable long-term survival to DBD transplantation and could help expand the U.S. donor heart pool.
Reference:
Cho, P. D., Kibel, T., Raina, A., Lander, M., Hadi, A., Kassis-George, H., Alpert, C., Ranganathan, K., Aldweib, N., Lee, C., & Tsukashita, M. (2026). National 6-Year Experience of Transplantation using Donor Hearts after Circulatory Death. The Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2026.09.002
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