Study Finds No Long-Term Survival Gap for Hearts From Circulatory Death Donors
A national registry analysis compared heart transplants from donors after circulatory death (DCD) with those after brain death. Over five years, survival rates were similar, though DCD recipients had higher rates of severe primary graft dysfunction. The findings support continued use of DCD hearts to expand the donor pool.
The analysis drew on 19,432 adult heart transplants recorded in the UNOS registry between December 2019 and December 2025, with DCD donors accounting for 13.3% of cases. Recipients of DCD hearts showed a more favorable baseline risk profile, including lower rates of pulmonary hypertension and less frequent ECMO support at the time of transplant, which may have influenced comparisons. Cross-clamp times were also longer in the DCD group.
Severe primary graft dysfunction occurred roughly twice as often with DCD hearts, yet survival curves remained statistically indistinguishable through five years. The authors noted that evolving procurement methods, such as the REUP technique that avoids cardiac reanimation, could further shift utilization patterns and outcomes as national experience grows.
This study could influence transplant center policies and patient counseling, offering reassurance that DCD hearts perform comparably over five years despite higher early graft dysfunction rates. For the roughly 3,000 patients awaiting heart transplants nationally, expanded DCD use may shorten wait times and reduce deaths on the list. However, lingering ethical questions about the dead-donor rule may continue to shape institutional adoption, and long-term data beyond five years remain limited.