Washington – September 15, 2026 -- Donation after circulatory death (DCD) heart transplantation expanded rapidly across the United States between 2019 and 2024 without any measurable decline in early clinical outcomes, according to research published in the September 2026 issue of the Journal of Cardiac Failure (JCF).
Registry data on 1,489 patients show no rise in graft failure or mortality
Investigators analyzed U.S. registry data covering 1,489 adult DCD heart transplant recipients, comparing the early adoption period of 2019-2021 with the national expansion period of 2022-2024. The analysis found no significant differences in one-year graft failure, mortality, need for renal replacement therapy, re-transplantation or hospital length of stay between the two periods. Outcomes remained consistent even among higher-risk recipients, as DCD transplantation spread to a growing number of transplant centers nationwide.
The findings support DCD transplantation as a viable strategy for expanding the donor heart pool without compromising safety, a critical consideration for transplant programs facing chronic organ shortages.
Guest editors frame a special issue on allocation reform and personalized care
The DCD study opens JCF's September special focus issue on heart transplantation, guest edited by Ersilia M. DeFilippis, MD, Randall C. Starling, MD, MPH, and Kiran Khush, MD, MAS. The issue addresses a field shifting after decades of relatively static immunosuppressive strategies and procurement techniques, driven by advances in donor heart procurement, preservation, noninvasive graft surveillance and post-transplant care.
Review calls for continuous urgency scores to replace categorical allocation tiers
A separate review, "Beyond Categorical Tiers: Improving Measurement of Medical Urgency as the Foundation for Heart Allocation Reform," argues that current therapy-based urgency tiers in the U.S. allocation system may not accurately reflect patients' true biological risk. The authors recommend validated continuous urgency scores built on objective measures, standardized exception criteria and allocation policies that more precisely assess medical need.
Immunosuppression research points toward individualized, AI-assisted risk assessment
A third review, "Beyond Tacrolimus: Towards Personalized Immunosuppression in Heart Transplantation," examines how differences in immune biology, comorbidities and alloimmune risk could inform individualized treatment protocols. The authors evaluate donor-specific antibodies, gene expression profiling and donor-derived cell-free DNA as tools for risk assessment, and outline future approaches including AI-assisted donor-recipient matching and continuous risk monitoring.
Additional contributions in the September issue cover emerging donor heart procurement and preservation techniques, international transplantation approaches, complex recipient populations, therapies for sensitized candidates and rejection, access to specialized transplant care, and patient experience research.