National 6-Year Experience of Transplantation using Donor Hearts after Circulatory Death.

Abstract

While the use of donation after circulatory death (DCD) hearts for heart transplantation (HTx) has expanded notably in the United States, long-term outcomes remain poorly characterized. This study aimed to assess national 5-year survival following DCD HTx. We queried the United Network for Organ Sharing database to identify adult heart transplant recipients from December 2019 to December 2025. Patients were stratified based on donor type: DCD vs donation after brain death (DBD). Baseline characteristics and peri-operative outcomes, including severe primary graft dysfunction (PGD; data captured from 9/2023-12/2025) and 30-day mortality, were compared. The Kaplan-Meier method was used to evaluate 5-year survival post-transplant. A total of 19,432 adult heart transplants were performed during the study period, with 13.3% (n=2,588) from DCD donors. Recipients of DCD hearts were less likely to be on extracorporeal membrane oxygenation (3.9% vs 8.1%, p<0.001), and donors of DCD hearts were younger (33 vs 34 years, p<0.001) than those of DBD hearts. Following transplantation, recipients of DCD hearts had a higher incidence of severe PGD (10.3% vs 5.3%, p<0.001) than those of DBD hearts, but experienced similar 30-day mortality (2.8% vs 2.7%, p=0.80) and 5-year survival (77.3% vs 78.3%, p=0.90). DCD HTx offers comparable long-term survival to DBD HTx, despite higher severe PGD. These findings provide reassurance and support continued expansion of DCD heart utilization in the United States.