Organ donation is a critical component of modern medicine, saving countless lives every year through the transplantation of viable organs. Traditionally, organ donors were primarily individuals declared brain-dead, meaning that while their brains had irreversibly ceased to function, their hearts continued to beat, supplying oxygen-rich blood to their organs. This distinction has long been important because organs harvested under these circumstances showed better post-transplant function and longer viability. However, a transformative shift has been unfolding in the United States over the past quarter century, as donation after circulatory death (DCD)—organ donation that occurs after the heart has stopped beating—has transitioned from a rare occurrence to a mainstream practice, fundamentally reshaping the donor landscape and expanding the pool of available organs for transplantation.
Donation after circulatory death involves a process whereby patients who do not meet brain death criteria but whose life support machines have been withdrawn are considered organ donors. When the decision is made to cease life-sustaining treatments, typically due to irreversible health conditions, the patient is given the option to undergo withdrawal in an operating theater rather than an intensive care unit. If the heart stops within a predetermined observational window following life support cessation, organ recovery can proceed immediately. This approach honors the patient’s and family’s wishes to donate while navigating complex ethical and logistical challenges related to organ viability during the period of circulatory arrest.
Unlike brain-death donors, where organs remain perfused with oxygenated blood until retrieval, DCD donors face a brief ischemic interval—the momentary lack of oxygen delivery to organs as circulation ceases. Historically, this ischemic insult was associated with increased organ damage, poor graft function, and heightened risk of transplant failure, leading to reluctance in widespread DCD adoption. Recent advances in medical technology and perfusion methods have mitigated these concerns. Techniques such as normothermic regional perfusion temporarily restore blood flow to organs with oxygenated blood after circulatory arrest but before procurement, effectively minimizing ischemic injury. Additionally, ex vivo machine perfusion systems allow further preservation and rehabilitation of organs outside the body by continuously delivering oxygen- and nutrient-rich fluids, thus enhancing organ quality and suitability for transplantation.
The impact of these innovations is profound. New data from researchers at NYU Langone Health reveal that while DCD donors accounted for a mere 2% of the total donor pool in 2000, they are projected to constitute close to half—49%—of all donors by 2025. This dramatic increase corresponds with a growing number of transplants involving DCD organs, particularly kidneys and livers, and an emerging application of these organs in lung, heart, and pancreas transplantation. The expanded acceptance of organs from DCD donors helps to address the critical shortage facing over 100,000 Americans awaiting lifesaving transplants, representing a major stride forward in public health and transplant medicine.
The evolving profile of DCD donors is notable for its departure from previous donor demographics. Current DCD donors tend to be older, possess higher body mass indexes, and often have comorbidities such as diabetes and hypertension—factors that historically might have disqualified donors or discouraged organ recovery. This trend is indicative of broader criteria acceptance, made possible by advanced preservation techniques and enhanced understanding of organ tolerance to ischemic injury. Consequently, a more diverse and extensive donor pool is emerging, promising to reduce waitlist mortality and improve access to transplantation for a wider patient population.
Despite these promising developments, donation after circulatory death varies widely across the United States. Geographic disparities exist, with some regions reporting DCD donors comprising up to 73% of their donor pools, while others lag substantially behind, with as little as 11%. These variations reflect differences in regional policies, practices, and the infrastructure supporting organ procurement organizations (OPOs), which coordinate donation activities. The inconsistency underscores the need for standardized guidelines and uniform protocols to ensure equitable access and optimize organ recovery nationwide.
Ethical considerations are central to the expanding adoption of DCD. Transparency and rigorous adherence to protocols that respect donor and family wishes, while safeguarding recipient safety, are paramount. Clear, consistent standards must be established and maintained to preserve public trust. Education and dialogue among clinicians, potential donors, and families are essential components of this process, ensuring informed consent and addressing concerns related to the timing of death determination and organ retrieval.
From a clinical perspective, ongoing research is focused on evaluating the long-term outcomes of organs transplanted from DCD donors compared to traditional brain-dead donors. Understanding graft survival, functional durability, and patient quality of life post-transplant remains a top priority. Moreover, efforts to refine donor identification and streamline recovery practices are underway, aiming to maximize organ yield and improve transplantation success rates.
The implications of these shifts extend beyond transplantation medicine alone. They highlight how technological innovation can disrupt entrenched medical paradigms and expand the possibilities of lifesaving interventions. The role of ex vivo perfusion technology exemplifies how bridging the gap between organ donation and successful transplantation can be achieved through the marriage of engineering and biology, transforming previously discarded organs into viable lifesaving resources.
Ultimately, the rise of DCD represents a hopeful advance in confronting the organ shortage crisis—a challenge of immense human and societal consequence. As this practice becomes more prevalent, the transplantation community must balance the promise of increased organ availability with the imperative to maintain ethical rigor, patient safety, and public confidence. The work of the NYU Langone research team, published in the esteemed Journal of the American Medical Association, offers both a critical assessment of progress and a roadmap for future innovations, underscoring the potential to save thousands more lives through refined organ donation strategies.
This surge in DCD transplantation is not only a testament to scientific and clinical advancement; it also embodies the resilience and generosity of donors and their families, affirming the profound societal impact of organ donation. As the healthcare system continues to evolve and technology progresses, donation after circulatory death stands at the forefront of expanding the gift of life, turning moments of profound loss into new beginnings for recipients nationwide.
Subject of Research: People
Article Title: Changes in Organ Donation After Circulatory Death in the United States
News Publication Date: 26 February 2026
Keywords: Organ donation, Transplantation
