Donation after circulatory determination of death in heart transplant: Impact on current and future allocation policy

Research output: Contribution to journalReview articlepeer-review


Purpose of reviewHistorically, the selection criteria for heart transplant candidates has prioritized posttransplant survival while contemporary allocation policy is focused on improving waitlist survival. Donor scarcity has continued to be the major influence on transplant allocation policy. This review will address the opportunity of donation after circulatory determination of death (DCDD) and potential impact on future policy revisions.Recent findingsIn 2018, changes to U.S. heart allocation policy led to several intended and unintended consequences. Beneficial changes include reduced waitlist mortality and broader geographic sharing. Additional impacts include scarcer pathways to transplant for patients with a durable left ventricular assist device, increased reliance on status exceptions, and expanded use of temporary mechanical support. DCDD is anticipated to increase national heart transplant volumes by ∼30% and will impact waitlist management. Centers that offer DCDD procurement will have reduced waitlist times, reduced waitlist mortality, and higher transplant volumes.SummaryWhile DCDD will provide more transplant opportunities, donor organ scarcity will persist and influence allocation policies. Differential patient selection, waitlist strategy, and outcome expectations may indicate that allocation is adjusted based on the procurement options at individual centers. Future policy, which will consider posttransplant outcomes, may reflect that different procurement strategies may yield different outcomes.

Original languageEnglish (US)
Pages (from-to)124-129
Number of pages6
JournalCurrent Opinion in Cardiology
Issue number2
StatePublished - Mar 1 2023


  • donation after circulatory determination of death
  • heart transplant
  • heart transplant waitlist

ASJC Scopus subject areas

  • Medicine(all)


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