- An analysis of U.S. organ donation data found donations after circulatory death rose sharply over 25 years.
- Donations occurring after irreversible loss of circulatory function increased from 2% in 2000 to 49% in 2025.
- Deceased donors supply the majority of transplanted organs in the U.S. and account for 75% of kidney transplants and 94% of liver transplants.
Organ donation after circulatory death (DCD) now accounts for nearly half of all deceased organ donors in the U.S., marking a dramatic shift in transplant practice over the past 25 years.
An analysis of national data from the Organ Procurement and Transplantation Network (OPTN) showed that donations occurring after irreversible loss of circulatory function increased from 2% of deceased donors in 2000 to 49% in 2025, reported Dorry L. Segev, MD, PhD, of NYU Langone Health in New York City, and colleagues in a research letter published in JAMA.
In absolute terms, DCD donors rose from 118 in 2000 to 8,129 in 2025. Donation after brain death also grew over the same period, though not as rapidly as DCD, going from 5,849 in 2000 to 8,416 in 2025.
The increase "is really a response to the severe shortage of organs that have been available for transplant over the inception of transplantation," co-author Macey Levan, JD, PhD, also of NYU Langone Health, told MedPage Today. "And it's really been enabled by organ recovery and preservation technologies that improve outcomes when those organs are used in transplant."
"People are getting transplanted faster by using a DCD organ versus waiting longer for an organ donated after brain death, and these new technologies, these profusion technologies, they're improving organ quality and utilization," Levan said. "So by reducing the amount of time that donated organs are deprived of oxygen and nutrients, these technologies really reduce the amount of organ damage that occurs between donation and transplantation. And so the more we're able to use technologies and the more people understand DCD, it's important."
Deceased donors supply most transplanted organs in the U.S., accounting for 75% of kidney transplants and 94% of liver transplants, as well as all heart, lung, and pancreas transplants from 2018 to 2025. "Improving transplant access therefore relies on expanding the deceased donor pool, including by increasing donation after circulatory death," the authors wrote.
By 2025, DCD accounted for 49% of recovered kidneys, 43% of livers, 24% of both lungs and hearts, and 12% of pancreata. Those proportions translated to 45% of deceased donor kidney transplants, 39% of liver transplants, 19% of lung transplants, 23% of heart transplants, and 10% of pancreas transplants.
Historically, most donated organs came from brain-dead patients whose circulation was maintained artificially. DCD involves recovery after irreversible circulatory cessation, typically following withdrawal of life support, and is only possible if death occurs within a limited time window.
In an accompanying editorial, Aleah L. Brubaker, MD, PhD, of the University of California San Diego, and colleagues cited a persistent organ shortage, long waiting lists, and high waiting-list mortality and candidate removal rates that led to a report from the National Academies of Sciences, Engineering, and Medicine in 2022 that offered "a blueprint for transformation" of donation and allocation.
"Expanding access to transplant with broader DCD use has disrupted the historic scarcity mentality and offers opportunity for system-level change," Brubaker and her team wrote.
Technological advances such as normothermic regional perfusion, which temporarily restores blood flow to organs after circulatory death, have contributed to the increase, the authors noted. The American College of Physicians, though, has criticized that method, warning in a 2021 statement that it raises "profound ethical questions regarding determination of death, respect for patients, and the ethical obligation to do what is best." But other new technologies are being developed that may help alleviate ethical concerns.
Researchers used OPTN data to identify all U.S. deceased donor organs recovered from January 2000 through December 2025. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology reporting guideline.
Contemporary DCD donors were older and more medically complex than in earlier eras. Donors from 2021-2025 had a median age of 50 and a median body mass index (BMI) of 28.7, compared with a median age of 43 and a median BMI of 25.6 for 2000-2005. More recent donors also were more likely to have hypertension, diabetes, hepatitis C virus, and anoxic causes of death.
The study also found wide variation across organ procurement organizations (OPO). In 2025, the proportion of donors recovered through DCD ranged from 11% to 73%, with 44% of OPOs reporting that over half of their donors were DCD. There was no correlation between an OPO's total donor volume and its proportion of DCD donors.
The authors noted limitations, including an inability to determine whether regional consent rates or center-specific transplant practices contributed to OPO-level variation in DCD recovery. They suggested that addressing the variation could improve transplant rates nationally and reduce geographic disparities in access.
Disclosures
The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases.
Husain reported a relationship with Novartis.
Co-authors reported relationships with AstraZeneca, Biosidus, Boehringer Ingelheim, CareDx, Hansa, Hansa Biopharma, Houston Methodist, IMS Legal Strategies, Johns Hopkins University, LiveOnNY, Moderna, Optum, OrganOx, Patients Like Me, Pro Cure On-Demand, Purdue University, Roche, Sanofi, Springer, Takeda Pharmaceuticals, the American Foundation for Donation and Transplantation, the Children's Organ Transplant Association, the Hastings Center, the Organ Procurement and Transplantation Network, the Scientific Registry of Transplant Recipients, the Texas Transplantation Society, the United Network for Organ Sharing, UC San Diego Health, Verici Dx, and Villanova University.
Brubaker had no disclosures.
Co-authors of the accompanying editorial reported relationships with Bristol Myers Squibb, Sanofi, the American Society of Transplantation, the OPTN Data Advisory Committee, the SRTR Review Committee, and Verici Dx.
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