Increasing Adoption of Donation After Circulatory Death in High Risk Heart Transplant Recipients: Insights Into Current Practices in the United States

This retrospective cohort study aimed to characterize the evolving utilization of donation after circulatory death (DCD) heart transplantation (HT) in high-risk (status 1–3) vs low-risk (status 4–6) recipients. Utilizing the United Network for Organ Sharing (UNOS) database (2019–2024; n=1,581), the authors observed a paradigm shift wherein DCD utilization for high-risk candidates surged to 75 percent by 2024. Despite significantly higher clinical acuity in the high-risk cohort, evidenced by greater dependence on mechanical ventilation and inotropes, post-transplant survival in this group was similar to that of low-risk recipients (p=0.122). While high-risk candidates experienced shorter total waitlist durations, adjusted DCD wait times increased significantly across all strata. The authors conclude that DCD HT is a safe and increasingly vital modality for high-risk patients, necessitating earlier consideration to mitigate prolonging waitlist times.