Organ Donation After Heart Stops Increases, Offering Hope Amid Shortage
A significant shift is occurring in organ donation practices in the United States, with a growing number of organs coming from individuals who died after their hearts stopped beating, rather than from those declared brain-dead. This change, known as donation after circulatory death (DCD), has the potential to substantially increase the availability of organs for transplant, but as well raises questions about public understanding and ethical considerations.
The Rise of Donation After Circulatory Death
Historically, the majority of organ donations came from individuals who were brain-dead, meaning they had irreversible cessation of all brain function. In these cases, the body is kept on a ventilator to preserve organ function until transplantation. But, DCD has seen a dramatic increase in recent years. In 2025, circulatory death accounted for 49% of all deceased donors in the U.S., a stark contrast to the 2% recorded in 2000. 1
This increase is attributed to technological advancements that help preserve organ quality as the heartbeat declines. A tool called normothermic regional perfusion temporarily restores blood flow to organs in the chest or abdomen – avoiding the brain – while surgeons carefully remove them. 3 This has enabled the leverage of organs from older and sicker donors after their hearts stop.
How Donation After Circulatory Death Works
DCD is an option for individuals with non-survivable injuries who do not meet the criteria for brain death and whose families choose to withdraw life support. Death is declared after the heart stops beating. A mandatory waiting period of five minutes is observed to ensure the heart does not restart. 1 Organ retrieval cannot begin until death is officially declared, and by law, donation and transplant groups are not involved in the decision to withdraw life support or present during the process. 3 If death does not occur within approximately two hours, the organs are no longer considered viable for transplant.
Geographic Variation and the Necessitate for Education
Research from NYU Langone Health indicates that the prevalence of DCD varies significantly across the United States. 2 Some organ procurement organizations (OPOs) report DCD accounting for over half of their donations, while others have rates as low as 11%. This disparity suggests that increased public education and training for local hospitals about DCD could further expand access to life-saving transplants.
Addressing Ethical Concerns and Strengthening Safeguards
While DCD offers a crucial opportunity to address the critical organ shortage – with over 100,000 Americans currently on the transplant waiting list 3 – recent reports of potential donors showing signs of life have raised concerns about trust in the transplant system. 1
The Health Resources and Services Administration is developing novel national policies to enhance safeguards for DCD. Proposed measures include allowing anyone questioning a donor’s suitability for life support withdrawal to request a pause, requiring documentation of appropriate neurological exams, and educating families about the DCD process. 1 The Association of Organ Procurement Organizations also advocates for withdrawing life support in the critical care unit to minimize public confusion.
Looking Ahead
The increasing reliance on donation after circulatory death represents a significant advancement in the field of organ transplantation. Continued refinement of protocols, coupled with robust ethical oversight and public education, will be essential to maximize the benefits of this practice and ensure equitable access to life-saving organs for all those in need.