DCD Heart Transplant Outcomes Remain Stable During Rapid U.S. Expansion

September special focus issue of the Journal of Cardiac Failure examines a changing era in heart transplantation, from donor expansion and allocation reform to personalized immunosuppression

WASHINGTON, Sept. 9, 2026 /PRNewswire/ -- Donation after circulatory death (DCD) heart transplantation expanded rapidly across the United States without evidence of worsening early outcomes, according to research featured in the September 2026 issue of the Journal of Cardiac Failure (JCF). 

The study of 1,489 adult DCD heart transplant recipients found no significant differences in one-year graft failure, mortality, renal replacement therapy or length of stay between the early adoption period of 2019–2021 and the broader expansion period of 2022–2024. Outcomes also remained consistent among higher-risk recipients, suggesting that DCD transplantation can expand without sacrificing early clinical outcomes.

The findings open 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 examines a field undergoing significant change after decades in which immunosuppressive strategies and surgical and procurement techniques remained relatively static. Recent advances in donor heart procurement and preservation, noninvasive graft surveillance and post-transplant care are creating new opportunities to expand transplantation and personalize care, while raising new questions about access, allocation and long-term outcomes.

Among the research, reviews and perspectives included in the September issue are:

DCD Heart Transplantation Expands Without Worsening Early Outcomes

In Stable Outcomes of Donation After Circulatory Death Heart Transplantation From Early Adoption to National Expansion, investigators analyzed U.S. registry data from 2019 through 2024.

DCD transplantation expanded to more centers without significant differences in one-year graft failure, mortality, re-transplantation, renal replacement therapy or length of stay. The findings support DCD transplantation as a strategy to expand the donor pool.

Rethinking How the U.S. Measures Transplant Urgency

A review, Beyond Categorical Tiers: Improving Measurement of Medical Urgency as the Foundation for Heart Allocation Reform, argues that current therapy-based urgency tiers may not accurately reflect patients' biological risk. The authors recommend validated continuous urgency scores based on objective measures, standardized exception criteria and allocation policies that more accurately assess medical need.

Toward Personalized Heart Transplant Immunosuppression

Beyond Tacrolimus: Towards Personalized Immunosuppression in Heart Transplantation examines how differences in immune biology, comorbidities and alloimmune risk could inform individualized treatment. The review considers donor-specific antibodies, gene expression profiling, donor-derived cell-free DNA and other tools for assessing risk and guiding immunosuppression. It also explores future approaches including AI-assisted donor-recipient matching and continuous risk assessment.

A Special Focus on a Field in Transition

These articles represent just part of the September focus issue. Additional contributions examine emerging donor heart procurement and preservation techniques, international approaches to transplantation, complex recipient populations, therapies for sensitized candidates and rejection, access to specialized transplant care, patient experiences, and perspectives on what heart replacement could look like decades from now.

Together, the issue captures both the progress and the unresolved questions defining contemporary heart transplantation: how to make more donor hearts available, allocate them more equitably, safely extend graft and patient survival, and tailor treatment to the individual recipient.

Beyond this special focus issue, JCF publishes leading heart transplantation research throughout the year and welcomes submissions that advance the science and clinical care of transplant patients.

Full Issue Available Online

The complete September 2026 issue of the Journal of Cardiac Failure includes these featured articles along with additional original investigations, reviews, and clinical research advancing the care of patients with heart failure. It is available online now. For interviews with authors, please contact Laura Poko at [email protected].

About the Journal of Cardiac Failure

The Journal of Cardiac Failure (JCF) publishes the highest quality science in the field of heart failure with a focus on diversity, equity, and inclusion, mentorship, multidisciplinary partnerships, and patient-centeredness. Published papers span original investigator-initiated work to state-of-the-art reviews, guidelines and scientific statements, expert perspectives, early career and trainee spotlight pieces, patient and patient-partner narratives. JCF also emphasizes the power of language and prioritizes innovative approaches to dissemination of published work to reach and impact the broader heart failure community.

About the Heart Failure Society of America

The Heart Failure Society of America, Inc. (HFSA) represents the first organized effort by heart failure experts from the Americas to provide a forum for all those interested in heart function, heart failure, and congestive heart failure (CHF) research and patient care. The mission of HFSA is to provide a platform to improve and expand heart failure care through collaboration, education, innovation, research, and advocacy. HFSA members include physicians, scientists, nurses, nurse practitioners, pharmacists, trainees, other healthcare workers, and patients. For more information, visit hfsa.org.

Media Contact: Laura Poko, 301-798-4493, ext. 226, [email protected] 

SOURCE Heart Failure Society of America