US researchers have found that while most organ donations once came from people who were brain-dead, they are now increasingly coming from people who died when their hearts stopped beating, a major shift that can boost transplants but also raises public confusion, reports AP.
What’s called donation after circulatory death, or DCD, jumped dramatically in a short period in the United States last year, accounting for 49% of all deceased donors, up from 2% in 2000.
Technology has helped overcome barriers to using those organs – ways to keep them from deteriorating as the heartbeat winds down – spurring this type of donation while the nation is hunting ways to overcome a dire shortage.
Specialists from NYU Langone Health found donation after circulatory death is far more common in some parts of the US than others, and suggest that better educating the public and local hospitals about the option could further increase access to lifesaving transplants.
The findings, published as a research letter in JAMA Network, come after some scary reports of potential donors who showed signs of life, shaking trust in the transplant system.
Additional safeguards are being developed by both federal officials and the non-profit organ procurement organisations that the government certifies to co-ordinate donation. The new findings may aid that policymaking.
“Donation after circulatory death is complex and we need to make sure we are doing it well,” said Dr Babak Orandi, an NYU transplant surgeon and study co-author. “If we stop doing it or severely restrict it, there would be pretty significant repercussions for patients.”
Different types of organ donation
While living donors can provide certain organs, most transplants are thanks to donations from the deceased. Brain death is declared when testing shows someone has no remaining brain function. If they’re a possible organ donor, the body is kept on a ventilator to support the organs until they’re retrieved.
Donation after circulatory death can be an option if someone has a non-survivable injury but all brain function hasn’t ceased, and the family chooses to end life support. Death occurs after the heart gradually stops beating.
Once that happens there’s a mandatory wait – five minutes, according to guidelines from the American Society of Transplant Surgeons – to be sure it won’t restart. Then the person’s doctor declares death.
By law, donation and transplant groups can’t participate in the decision to end life support, and they’re not in the room when it’s withdrawn. Organ retrieval cannot begin until death is declared. If death doesn’t occur quickly enough, within about two hours, the organs aren’t usable and retrieval isn’t attempted.
Variation in who donates
To track the donor evolution, the NYU team analysed data from the US' Organ Procurement and Transplantation Network, and from 55 OPOs that recover organs in assigned regions countrywide.
Last year, circulatory death accounted for more than half of the donors at 24 organ donation agencies. But it varied widely, with some accounting for as little as 11% of donors.
Hospital resources play a role, according to the Association for Organ Procurement Organisations. Decisions to withdraw life support are common, but small or rural hospitals may not be as familiar with the extra steps involved with donation.
Another factor is whether hospitals have adopted that new technology. The quality of organs can suffer as the heart stops, briefly depriving them of oxygen.
After death is declared, a tool called normothermic regional perfusion allows surgeons to temporarily restore that blood flow to organs in the chest or abdomen – avoiding the brain – while they do the delicate work of removing them.
It has helped enable use of organs from older, sicker donors after their hearts stop. But even temporarily restoring blood flow after death has raised ethical questions.
New policies for donation after circulatory death
The Health Resources and Services Administration is preparing new national policies to improve safeguards for this type of donation. One proposal would allow anyone involved with a potential donor who questions if their condition is right for life support withdrawal to call for a pause in those preparations.
Other proposals would require OPOs to document that the hospitals caring for the potential donor are performing appropriate neurological exams, and to educate families of potential DCD donors about the steps required.
The Association of Organ Procurement Organisations has some similar guidelines and some OPOs already have created checklists to help hospitals.
The group also urges withdrawing life support in the critical care unit, not in an operating room, to help avoid public confusion about when death occurs and when organ groups step in, said association President Jeff Trageser.
Study details
Changes in Organ Donation After Circulatory Death in the United States
Syed Ali Husain, Jennifer Motter, Darren Stewart, et al.
Published in JAMA Network on 26 February 2026
Organ transplant improves survival and quality of life, but transplant access is limited by organ shortages. Transplants in the US predominantly use deceased donor organs, including 75% and 94% of kidney and liver transplants, respectively, and all lung, heart, and pancreas transplants from 2018 to 2025.1 Improving transplant access therefore relies on expanding the deceased donor pool, including by increasing donation after circulatory death (DCD), in which organs are recovered from donors with irreversible loss of circulatory function. Factors limiting DCD use include a higher risk of organ dysfunction compared with donation after brain death organs and the increased complexity of DCD organ recovery, which is not possible if the time between life support withdrawal and circulatory death is prolonged.2 Despite these limitations, the severe organ shortage combined with technological innovations that enhance DCD organ function have increased interest in DCD organ transplant by transplant programs and organ procurement organizations (OPOs), the federal contractors responsible for coordinating US organ recovery and allocation. This study aimed to describe secular trends in DCD donation.
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