The United Kingdom National Programme of DCD heart transplantation: timings, techniques, feasibility, and outcomes with abdominal normothermic regional perfusion
Morcos, Karim Simmonds, Lewis Rushton, Sally Hogg, Rachel Messer, Simon Macklam, Debbie Husain, Mubbasher Large, Stephen Tsui, Steven Kaul, Pradeep
Morcos, Karim
Simmonds, Lewis
Rushton, Sally
Hogg, Rachel
Messer, Simon
Macklam, Debbie
Husain, Mubbasher
Large, Stephen
Tsui, Steven
Kaul, Pradeep
Abstract
Background: The United Kingdom (UK) was one of the first countries to pioneer donation after circulatory death (DCD) heart transplants. To establish equitable access to DCD hearts, a nationally-funded DCD program was established in 2020. We report the results of this program and examine retrieval techniques, ischemic times and survival.
Methods: This multi-center, retrospective, observational study compared DCD versus donation after brain death (DBD) heart transplant outcomes from 2020 to 2024. DCD hearts were retrieved using direct procurement and perfusion (DPP) with/without abdominal normothermic regional perfusion (A-NRP). Primary outcomes were 1-year survival and severe primary graft dysfunction (PGD). Ischemic times, cannulation techniques, and A-NRP status were analyzed.
Results: There were 188 DCD and 523 DBD heart transplants. There was no difference in 30-day (96% DCD vs 95% DBD, p = 0.76) or 1-year survival (87% DCD vs 88% DBD, p = 0.81). There was no difference in severe PGD (unadjusted analysis; 28% DCD vs 24% DBD, p = 0.26). DPP with A-NRP increased ischemic timings (asystole to cardioplegia delivery, 15 mins (n = 22; A-NRP/DPP) vs 13 mins (n = 166; DPP, p = 0.0022). Propensity-matched analysis showed no difference in 90-day survival (86.4% vs 88.6%; p = 0.7828). Papworth cannulation technique reduced ischemic times with no impact on outcomes. Longer implant (p = 0.03) and ex-situ perfusion (p = 0.02) times were associated with severe PGD/death at 1 year.
Conclusion: DCD heart donation increased UK heart transplantation by 36% compared with DBD alone, with results comparable to DBD. A-NRP/DPP is feasible but prolongs ischemic times, although survival was similar to the DPP group. The main predictors of poor 1-year survival were implant and ex-situ perfusion times.
MIDER Authors
Affiliations
Date
2026-05-04
Type
Article
Subject
Collections
Citation
Morcos K, Simmonds L, Rushton S, Hogg R, Messer S, Macklam D, Husain M, Large S, Tsui S, Kaul P, Smail H, Mohite P, Priasamy SA, Baxter J, Nunes J, Pettit S, Curry P, Doshi H, Nair S, Osman M, Page A, Zych B, Monteagudo-Vela M, Ranasinghe A, Mukadam M, Quinn D, Mehta V, Pai V, Russell D, Saez DG, Venkateswaran R, Ramesh BC, Dronavalli V, Jungschleger J, Kenny L, Simmonds J, Macgowan G, Reinhardt Z, Speed J, Parameshwar J, Jenkins D, Watson S, Marley F, Ali A, Gardner D, Rubino A, Whitney J, Slater C, Armstrong L, Foley J, Ryan M, Gibson S, Quinn K, Macleod AM, Spence S, Johnston C, Butler A, Watson C, Clarkson A, Manas D, Currie I, Berman M. The United Kingdom National Programme of DCD heart transplantation: Timings, techniques, feasibility, and outcomes with abdominal normothermic regional perfusion. J Heart Lung Transplant. 2026 May 4:S1053-2498(26)01905-4. doi: 10.1016/j.healun.2026.04.027. Epub ahead of print.