Donation after circulatory death now accounts for nearly half of all deceased organ donors in the United States. Advances in preservation technology are helping make more organs usable and saving more lives.
More than 100,000 Americans are currently waiting for a lifesaving transplant.
A growing share of those organs now comes from donors whose hearts have stopped beating rather than from those declared brain dead.
Organ donation after the heart stops beating, known as donation after circulatory death, was once rare in the United States. Over the past 25 years, it has become routine. Researchers say this shift is expanding the donor pool and making more transplants possible (1✔ ✔Trusted Source
Changes in Organ Donation After Circulatory Death in the United States
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Led by NYU Langone Health researchers, the new analysis traced how the deceased-donor pool has evolved. According to the results, circulatory-death donors climbed from 2% of all donors in 2000 to 49% of donors in 2025. Their organs are now a major source of kidneys and livers. They are also increasingly used for lung, heart, and pancreas transplants.
“Our findings reveal that a rise in donations after circulatory death makes organ transplantation possible for thousands of patients who might otherwise die on the waitlist,” said study lead author Syed Ali Husain, MD, MPH.
Most donated organs historically came from people declared brain dead, notes Husain, an assistant professor in the Departments of Surgery and Medicine at the NYU Grossman School of Medicine. Because the heart continues to beat after brain death, tissues continue to receive oxygen-rich blood.
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If the patient dies within a set time after support is removed, organs can be recovered and used for transplantation. This preserves the opportunity to donate according to the wishes of the patient and family.
Previously, these organs were considered less reliable. Since blood flow stops when the heart stops beating, organs may briefly go without oxygen and nutrients. This raised concerns about how well they would function after transplant.
How Did Circulatory-Death Donation Become So Common?
During the past decade, new tools have helped overcome earlier limitations. These advances may explain the rapid rise in circulatory-death donation.
Normothermic regional perfusion temporarily restores blood flow to organs after the heart stops. Machine perfusion devices pump oxygen- and nutrient-rich fluid through organs after they are removed from the body. Both approaches reduce damage and make more organs suitable for transplantation.
These technologies also allow surgeons to use organs from donors who may once have been excluded. The study showed that today’s circulatory-death donors tend to be older. They often have a higher body mass index. They are also more likely to have conditions such as diabetes or high blood pressure compared to similar donors in earlier years.
For the investigation, researchers analyzed data from the Organ Procurement & Transplantation Network. This database tracks every organ recovered in the United States. They calculated the yearly share of circulatory-death donors and the number of kidney, liver, lung, heart, and pancreas transplants performed. Recovery patterns across 55 organ procurement organizations were also assessed.
The researchers found wide geographic variation. In some regions, donation after circulatory death accounted for as much as 73% of donors. In others, it was as low as 11%.
Can Better Standards and Education Improve Public Trust?
“Our results highlight the opportunity to further grow donation after circulatory death and save even more lives,” said study co-senior author Dorry Segev, MD, PhD.
“Clear, consistent standards for donation after circulatory death are important so patients are protected and the public is assured that the process is safe,” said study co-senior author Babak Orandi, MD, PhD.
“As donation after circulatory death becomes more common, expanded education and dialogue with patients, families, and clinicians will be essential to maintaining that trust,” added study co-author Macey Levan, JD, PhD.
According to Levan, the team plans to explore ways to improve donor identification and recovery practices. They will also examine how well organs from circulatory-death donors perform over time compared with those from brain-dead donors.
Reference:
- Changes in Organ Donation After Circulatory Death in the United States – (https://jamanetwork.com/journals/jama/article-abstract/2845586)
Source-Journal of the American Medical Association