National registry data show that heart transplants utilizing organs donated after circulatory death (DCD) achieve long-term survival rates comparable to those using traditional donation after brain death (DBD) hearts, according to a study published in the Annals of Thoracic Surgery. Researchers tracking 19,432 adult heart transplants recorded through the United Network for Organ Sharing (UNOS) database between December 2019 and December 2025 found that 30-day mortality and 5-year survival remained nearly identical between the two donor types.
Registry Data Reveals Identical Five-Year Survival Rates
According to the UNOS registry analysis, DCD heart transplants yielded a 30-day mortality rate of 2.8%, nearly matching the 2.7% rate observed in DBD transplants, with a P-value of 0.80. Five-year survival rates tracked similarly at 77.3% for DCD recipients and 78.3% for DBD recipients, according to the study data. The authors noted that similar 1-year survival rates across early and later eras suggest national dissemination of DCD heart transplants occurred without a pronounced learning-curve effect.
Did you know? DCD heart transplants have grown steadily across the United States since the first recorded case in December 2019, driven by an urgent need to expand the organ donor pool.
Managing Primary Graft Dysfunction Risks in DCD Transplants
Despite matching long-term survival milestones, recipients of DCD hearts faced a higher incidence of severe primary graft dysfunction (PGD), occurring in 10.3% of cases compared with 5.3% for DBD recipients, with a P-value of less than 0.001. Study investigators attributed this excess risk to warm ischemic injury incurred during the agonal phase of procurement. However, researchers observed that current ex situ and in situ perfusion technologies may partially reverse this effect, explaining why it did not negatively impact long-term patient survival.
Comparing Procurement Techniques: Normothermic Regional Perfusion Versus Direct Procurement
The study evaluated differences between two standard DCD procurement strategies. Investigators found that approximately one in three DCD hearts utilized normothermic regional perfusion (NRP), which was independently associated with lower in-hospital mortality, yielding an adjusted odds ratio of 0.51 and a 95% confidence interval ranging from 0.30 to 0.88, when compared directly with direct procurement and perfusion (DPP). Five-year survival rates remained comparable between the NRP and DPP groups at 83.9% and 75.4%, respectively. The authors cautioned that these findings rely on surrogate classifications inferred from recorded time intervals between the declaration of circulatory death and aortic cross-clamp, as the UNOS database did not track specific procurement details.
| Metric | DCD Hearts | DBD Hearts |
|---|---|---|
| 30-Day Mortality | 2.8% | 2.7% |
| 5-Year Survival | 77.3% | 78.3% |
| Severe Primary Graft Dysfunction | 10.3% | 5.3% |
Frequently Asked Questions
What is donation after circulatory death (DCD)?
DCD involves organ recovery after the irreversible loss of circulatory function, offering an alternative to traditional donation after brain death to help address the severe shortage of available organs.
How do DCD heart transplant survival rates compare to DBD transplants?
According to UNOS registry data published in the Annals of Thoracic Surgery, 5-year survival rates are comparable, standing at 77.3% for DCD recipients and 78.3% for DBD recipients.
Why do DCD heart recipients experience higher rates of primary graft dysfunction?
Researchers attribute the increased rate of severe primary graft dysfunction to warm ischemic injury sustained during the agonal phase of procurement.
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