Introduction
Organ transplantation improves survival and quality of life, but transplant access is limited by organ shortages. Transplants in the U.S. predominantly use deceased donor (DD) organs, including 75% and 94% of kidney and liver transplants, respectively, and all lung, heart, and pancreas transplants from 2018–2025.1 Improving transplant access therefore relies on expanding the DD pool, including by increasing donation after circulatory death (DCD), in which organs are recovered from donors with irreversible loss of circulatory function. Factors limiting DCD use include a higher risk of organ dysfunction versus donation after brain death (DBD) organs and the increased complexity of DCD organ recovery, which is not possible if the time between life support withdrawal and circulatory death is prolonged.2 Despite these limitations, the severe organ shortage combined with technological innovations that enhance DCD organ function have increased interest in DCD organ transplantation by transplant programs and organ procurement organizations (OPOs), the federal contractors responsible for coordinating U.S. organ recovery and allocation. This study aimed to describe secular trends in DCD donation.
Methods
The institutional review board of NYU Langone Health determined that this study of deidentified data did not constitute human subjects research and waived consent. This study used Organ Procurement and Transplantation Network (OPTN) data to identify all U.S. DD recovered 01/01/2000–12/31/2025. Based on OPTN data as of 01/16/2026, the following were calculated: annual proportion of DCD donors; annual proportion of kidneys, livers, lungs, hearts, and pancreata recovered and transplanted from DCD donors; OPO-level proportion of DCD donors in 2025; and the correlation between OPO-level total number of donors and proportion of DCD donors in 2025 using Spearman correlation coefficient. Descriptive statistics were used to compare characteristics of DCD donors across 5 eras: 2000–2005, 2006–2010, 2011–2015, 2016–2020, and 2021–2025. Analyses were performed using Stata 18, using 2-sided tests with α=.05.
Results
DCD donors rose from 118 in 2000 (2% of all donors) to 8129 in 2025 (49%), while DBD donors rose from 5,849 to 8416 (Figure 1A). A rise in DCD recovery was observed for all organs: 49%, 43%, 24%, 24%, and 12% of recovered kidneys, livers, lungs, hearts, and pancreata were DCD by 2025 (Figure 1B), corresponding to 45%, 39%, 19%, 23%, and 10% of DD transplants, respectively. There was OPO-level heterogeneity in DCD donor recovery even in 2025 (ranging from 11% to 73% of donors), and >50% of donors at 24 (44%) OPOs were DCD, with no OPO-level correlation (ρ=0.02, p=0.9) between the proportion of DCD donors and total recovery volume. The OPO-level rise in the number of recovered donors from 2000 to 2025 ranged from 76% to 767%. Compared to earlier eras, contemporary DCD donors were older; had higher BMI; were more likely to have diabetes, hypertension, and hepatitis C; and were more likely to have died due to anoxia (Table 1).
Figure 1. Trends in donation after circulatory death (DCD) over time in the United States.
(Panel A) Bars represent annual counts of donation after brain death (DBD) (blue) and DCD (orange) donors (left y-axis), 2000–2025. Line represents DCD donors as a percentage of all deceased donors (right y-axis). The proportion of DCD donors in the US increased from 2% in 2000 to 49% in 2025, a period in which the number of DCD donors increased from 118 in 2000 to 8129 in 2025, while DBD donors rose from 5,849 to 8416. (Panel B) Lines represent DCD organs as a percentage of all deceased donor organs recovered for transplant, 2000–2025. An increase in DCD organ recovery was seen across all organ types, although was most pronounced for kidneys and livers.
DCD, donation after circulatory death; DBD, donation after brain death.
Table 1.
Characteristics of donation after circulatory death (DCD) donors from 2000–2025.
| Characteristic | 2000–2005 (n=1702) | 2006–2010 (n=4145) | 2011–2015 (n=6157) | 2016–2020 (n=11641) | 2021–2025 (n=30273) | p-valuea |
|---|---|---|---|---|---|---|
| Age (years), median (IQR) | 43 (24, 53) | 43 (26, 52) | 41 (26, 51) | 43 (30, 53) | 50 (38, 59) | <0.001 |
| Missingb, no. (%) | 0/1702 (0.0) | 0/4145 (0.0) | 0/6157 (0.0) | 0/11641 (0.0) | 2015/30273 (6.7) | |
| Sex, no. (%) | 0.31 | |||||
| Male | 1101 (64.7) | 2692 (64.9) | 3998 (64.9) | 7553 (64.9) | 19370 (64.0) | |
| Female | 601 (35.3) | 1453 (35.1) | 2159 (35.1) | 4088 (35.1) | 10903 (36.0) | |
| BMI (kg/m2), median (IQR) | 25.6 (22.4, 30.1) | 26.7 (23.1, 31.4) | 26.8 (22.9, 31.7) | 27.7 (23.8, 32.8) | 28.7 (24.3, 34.2) | <0.001 |
| Missingb, no. (%) | 19/1702 (1.1) | 40/4145 (1.0) | 95/6157 (1.5) | 94/11641 (0.8) | 2439/30273 (8.1) | |
| Pre-donation hypertension, no. (%) | <0.001 | |||||
| No | 1275 (75.1) | 2990 (72.5) | 4450 (72.5) | 7630 (66.0) | 15365 (50.8) | |
| Yes | 423 (24.9) | 1132 (27.5) | 1687 (27.5) | 3933 (34.0) | 14530 (48.0) | |
| Missing | 4/1702 (0.2) | 23/4145 (0.6) | 20/6157 (0.3) | 78/11641 (0.7) | 378/30273 (1.2) | |
| Serum creatinine (mg/dL), median (IQR) | 0.9 (0.7, 1.3) | 0.9 (0.6, 1.2) | 0.8 (0.6, 1.1) | 0.8 (0.6, 1.2) | 0.9 (0.6, 1.4) | <0.001 |
| Missingb, no. (%) | 2/1,720 (0.1) | 7/4145 (0.2) | 2/6157 (0.03) | 0/11641 (0.0) | 2475/30273 (8.2) | |
| Blood type, no. (%) | 0.31 | |||||
| A | 638 (37.5) | 1673 (40.4) | 2366 (38.4) | 4465 (38.4) | 11644 (38.5) | |
| B | 183 (10.8) | 460 (11.1) | 665 (10.8) | 1271 (10.9) | 3228 (10.7) | |
| AB | 57 (3.3) | 130 (3.1) | 235 (3.8) | 409 (3.5) | 1013 (3.3) | |
| O | 824 (48.4) | 1882 (45.4) | 2891 (47.0) | 5496 (47.2) | 14388 (47.5) | |
| HCV antibody, no. (%) | <0.001 | |||||
| Negative | 1627 (95.6) | 4030 (97.2) | 6015 (97.7) | 10862 (93.3) | 27690 (91.5) | |
| Positive | 60 (3.5) | 115 (2.8) | 142 (2.3) | 779 (6.7) | 2583 (8.5) | |
| Missing | 15 (0.9) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0.0 (0.0) | |
| Cause of death, no. (%) | <0.001 | |||||
| Anoxia | 488 (28.7) | 1542 (37.2) | 2843 (46.2) | 6054 (52.0) | 15701 (51.9) | |
| Head Trauma | 650 (38.2) | 1408 (34.0) | 1840 (29.9) | 2732 (23.5) | 5186 (17.1) | |
| Cerebrovascular/Stroke | 447 (26.3) | 932 (22.5) | 1157 (18.8) | 2250 (19.3) | 6603 (21.8) | |
| Other | 117 (6.9) | 263 (6.3) | 317 (5.1) | 605 (5.2) | 2783 (9.2) | |
| KDPI (%)c, median (IQR) | 45 (27, 67) | 45 (28, 64) | 44 (27, 62) | 48 (30, 67) | 62 (40, 82) | <0.001 |
| Missingb, no. (%) | 16/1702 (0.9) | 43/4145 (1.0) | 12/6157 (0.2) | 2/11641 (0.02) | 2016/30273 (6.7) |
Abbreviations: BMI, body mass index; HCV, hepatitis C virus; IQR, interquartile range; KDPI, kidney donor profile index; no., number.
p-values were obtained using Kruskal-Wallis test for continuous data and Pearson’s chi-squared test for binary or categorical data.
Age, BMI, serum creatinine, and KDPI were not available for donors with a recovery date after September 30, 2025 (number missing for all variables=2015).
Kidney Donor Profile Index (KDPI) is a percentile-based score ranging from 0% (lowest risk) to 100% (highest risk) that ranks deceased donor kidney quality relative to all kidneys recovered in the reference year (2024); higher scores indicate increased predicted risk of post-transplant graft failure. For example, a donor with a KDPI of 80% has higher predicted risk of graft failure than 80% of all deceased donor kidneys recovered in 2024.
Discussion
DCD donors now comprise about half of DD, including most donors at 44% of OPOs. Further, contemporary DCD donors are more medically complex than those from prior eras. This growing reliance on DCD organs to maintain transplant access necessitates establishing best practices in DCD organ selection, preservation, and allocation. Recent innovations have facilitated recovery from medically complex DCD donors.3,4 Normothermic regional perfusion, in which perfusion is restored in situ to limited organs after circulatory death, contributed to the rise in recovery of DCD organs since its use began increasing in 2019.4,5 The regulatory approval of normothermic machine perfusion for livers (2021) contributed to the subsequent acceleration of DCD liver recovery, and normothermic machine perfusion enabled the advent of DCD heart transplantation in 2019.6 Study limitations include an inability to analyze whether regional differences in donation consent rates or center DCD organ acceptance practices contribute to OPO heterogeneity in DCD organ recovery. Nevertheless, OPO-level heterogeneity in DCD recovery suggests opportunities exist to improve transplant rates nationally and ensure that varying DCD practices do not lead to geographic disparities in transplant access.
Funding/Support:
Dr. Husain was supported by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant K23DK133729.
Role of the funder/sponsor:
The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Abbreviations:
- DCD
donation after circulatory death
- DD
deceased donor
- OPO
organ procurement organization
- OPTN
Organ Procurement and Transplantation Network
Footnotes
Conflict of Interest Disclosures: Dr. Husain reports consulting fees from Novartis. Dr. Orandi reports having served on an advisory board for Boehringer Ingelheim. Mr. Stewart reports consulting fees from Hansa Biopharma. No other disclosures were reported.
Disclaimer: The data reported here have been supplied by the United Network for Organ Sharing as the contractor for the Organ Procurement and Transplantation Network. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the OPTN or the U.S. Government.
Data Sharing Statement:
The data used for this analysis are available upon request from the OPTN.
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data used for this analysis are available upon request from the OPTN.