Safely Increasing Heart Transplantation with Donation after Cardiac Death

This editorial discusses the clinical, ethical, and logistical considerations surrounding heart transplantation from donors after circulatory death (DCD). Referencing results from the Donors after Circulatory Death Heart Trial, the piece highlights that 6-month survival was noninferior for DCD heart recipients (95%) compared to those receiving hearts from brain-dead donors (89%). Nearly 90% of eligible DCD hearts were successfully transplanted, suggesting that DCD programs could meaningfully expand donor supply. Although early graft dysfunction was more common in the DCD group (15% vs. 5%), these cases were manageable, and graft failure occurred only in the control group. The author stresses institutional infrastructure and ethical coordination needed for Maastricht category III DCD protocols, involving controlled withdrawal of life support. Importantly, DCD hearts were rarely allocated to the sickest recipients (UNOS status 1 or 2), exposing a knowledge gap in outcomes for critically ill patients. Future use of ex vivo perfusion systems may further extend viability windows and improve utilization of marginal hearts

This editorial discusses the clinical, ethical, and logistical considerations surrounding heart transplantation from donors after circulatory death (DCD). Referencing results from the Donors after Circulatory Death Heart Trial, the piece highlights that 6-month survival was noninferior for DCD heart recipients (95%) compared to those receiving hearts from brain-dead donors (89%). Nearly 90% of eligible DCD hearts were successfully transplanted, suggesting that DCD programs could meaningfully expand donor supply. Although early graft dysfunction was more common in the DCD group (15% vs. 5%), these cases were manageable, and graft failure occurred only in the control group. The author stresses institutional infrastructure and ethical coordination needed for Maastricht category III DCD protocols, involving controlled withdrawal of life support. Importantly, DCD hearts were rarely allocated to the sickest recipients (UNOS status 1 or 2), exposing a knowledge gap in outcomes for critically ill patients. Future use of ex vivo perfusion systems may further extend viability windows and improve utilization of marginal hearts