Circulatory Death Organ Donation Rises in US: Trends & Regional Variation

Kidney transplant access continues to expand thanks to increasing rates of donation after circulatory death (DCD), a practice that has grown significantly over the past quarter-century. While kidney transplants from deceased donors still represent the majority – three-quarters of all kidney transplants in the U.S. – the proportion now coming from circulatory death donors has reached 45%, according to data published in JAMA on March 3, 2026. This shift reflects both advancements in organ preservation techniques and a willingness among transplant centers to utilize organs from donors who might not have been considered suitable candidates in the past.

The increase in DCD donations, from 2% of all deceased donors in 2000 to 49% in 2025, is a notable development in addressing the chronic shortage of organs available for transplant. Researchers, led by Macey L. Levan, JD, PhD, of NYU Grossman School of Medicine, analyzed data from the Organ Procurement and Transplantation Network (OPTN) to track these trends. The study also showed increases in DCD donations for other organs, including livers, hearts, lungs, and pancreases, though to a lesser extent than kidneys.

Expanding the Donor Pool: A Technological Push

Historically, organs were primarily recovered from donors who had suffered brain death, where circulation is maintained artificially. DCD involves the retrieval of organs after cardiac arrest, when circulation has ceased. This presents unique challenges in terms of organ preservation and potential damage due to lack of oxygen. Yet, innovations like normothermic regional perfusion (NRP) and machine perfusion are mitigating these concerns. NRP, for example, cools and perfuses organs with oxygenated fluids, reducing damage and improving function. Subnormothermic acellular machine perfusion further enhances preservation during transport and allocation.

“Normothermic regional perfusion reduces damage to kidneys donated after circulatory death and therefore improves how they function after transplant,” explained Levan in a statement to Healio. “An even newer technology, subnormothermic acellular machine perfusion, also facilitates transplant through better preservation during allocation and transport.”

Geographic Variation and Donor Characteristics

While the overall trend is positive, the study highlights significant variability in DCD rates across different organ procurement organizations (OPOs). In 2025, DCD rates ranged from 11% to 73% of all donors, suggesting that opportunities exist to expand access to transplantation in certain regions. This variation may be due to differences in local policies, infrastructure, and acceptance of DCD among transplant centers.

Interestingly, the characteristics of DCD donors have also evolved. More organs are now being recovered from donors who are older, have a higher body mass index (BMI), and have pre-existing conditions like hypertension, diabetes, and hepatitis C. The researchers noted a decline in the median Kidney Donor Profile Index (KDPI) – a measure of kidney quality – from 48 in 2016-2020 to 64 in 2021-2025 for kidneys recovered from DCD donors. This indicates that organs from less-ideal donors are increasingly being utilized, facilitated by the aforementioned preservation technologies and a broader acceptance of risk.

What Does This Mean for Patients?

The increasing utilize of DCD organs has the potential to significantly reduce wait times for kidney transplants. For many patients with end-stage renal disease, a transplant offers a better quality of life and improved survival compared to long-term dialysis. However, it’s important to note that organs from DCD donors may have different characteristics and potential risks compared to those from brain-dead donors. Transplant centers carefully evaluate each donor organ and match it to a suitable recipient, taking these factors into consideration.

Levan emphasized that the transplant community is continually seeking ways to expand the pool of usable organs. “The transplant community is constantly working on ways to safely expand the types of donated organs that can be used so that more patients can receive the life-saving benefits of transplants,” she said. “An increase in donation after circulatory death has expanded access to transplant and helped reduce the organ shortage.”

The Broader Context of Organ Donation

The rise in DCD donations is part of a larger effort to address the critical shortage of organs for transplantation. Other strategies include increasing public awareness of organ donation, improving the efficiency of the organ allocation system, and exploring innovative technologies like xenotransplantation (transplanting organs from animals). Recent advancements in implantable dialysis devices also offer a potential bridge to transplant for some patients, providing a temporary solution while they await a donor organ.

Looking Ahead: Continued Research and Refinement

Levan and her colleagues suggest that ongoing research is needed to further optimize organ procurement and preservation techniques. This includes investigating recent methods for assessing organ quality, refining machine perfusion protocols, and identifying strategies to minimize the risk of complications associated with DCD organs. The researchers also highlight the importance of addressing disparities in DCD rates across different regions and ensuring equitable access to transplantation for all patients. The full study published in JAMA details the methodology and findings, offering a comprehensive overview of the evolving landscape of organ donation.

The future of transplantation will likely involve a combination of these approaches – technological innovation, improved organ preservation, and increased public awareness – all working together to ensure that more patients receive the life-saving organs they require. For individuals considering organ donation, resources are available through organizations like the United Network for Organ Sharing (UNOS) and Donate Life America.