How Donors Died May Not Matter for Long-Term Heart Transplant Outcomes
How Donors Died May Not Matter for Long-Term Heart Transplant Outcomes
10-Year Outcomes Support Modern DCD Heart Transplantation (Donation after Circulatory Death (DCD))
Source: JACC: Heart Failure
Date: June 10, 2026.
• Donation after Brain Death (DBD) remains the current gold standard for heart transplantation. After donor heart procurement, the heart is preserved on ice (cold storage) and transported to the recipient center.
• Cold Ischemic Time (CIT) is the period the donor heart remains outside the body without blood supply, from procurement until reperfusion after implantation. It includes transport and surgical implantation time and is generally kept below 4 hours.
• Donation after Brain Death (DBD) remains the primary source of donor hearts and the current gold standard for heart transplantation. More recently, Donation after Circulatory Death (DCD) has emerged as an effective alternative with the Organ Care System (OCS), which transports the donor heart warm, perfused, and beating instead of on ice, safely expanding the donor pool without compromising long-term outcomes.
• In DCD, after circulation stops, the donor heart is removed and then connected to the Organ Care System (OCS). The brief period without blood flow between circulatory arrest and OCS support is called Warm Ischemic Time (WIT), and every additional minute increased the risk of primary graft dysfunction.
• Despite this additional ischemic period, 10-year survival was comparable between DCD and DBD heart transplantation (67% vs 64%), supporting the safe expansion of the donor heart pool.
DOI: https://doi.org/10.1016/j.jchf.2026.103168
