How Donation after Cardiac Death is Changing the Transplant Landscape

Seventeen people lose their lives each day while waiting for an organ transplant.

However, a groundbreaking shift in transplant technology is expanding possibilities and saving more lives.

Heart disease is the lead causing of death in the United States, but historically waiting on a heart transplant can take time patients do not have. The way a person dies affects which organs and tissues can be donated. Until recently, there were restrictions around organ donations that made heart donations especially challenging. With previous restrictions, an organ donor had to experience brain death, or the permanent and irreversible loss of all brain function.

Now, heart donations are possible after the donor has experienced cardiac death—meaning their circulatory and respiratory functions have stopped.

Donation after cardiac death (DCD) helps ease the critical shortage of hearts and other organs in the United States. Thanks to emerging technology in recent years, DCD is becoming a new frontier for heart transplantation.

As of September 2024, more than 103,000 adults and children in the U.S. are waiting for an organ transplant. While more than 46,000 transplants were performed in 2023, the need for organs far outweighs the supply.

DCD opens the door for more lifesaving transplants. It allows for more organ donations after the heart stops beating, increasing the number of available organs. This approach also gives patients the chance to receive healthier organs and a fresh start in life.

Emory Healthcare is at the forefront of heart transplant surgery and lifesaving technology. We’re a national leader in heart transplantation and home to Georgia’s first and largest heart transplant program.

Working with partners like LifeLink of Georgia, we’re the eighth-largest DCD organ program in the country. As the first and only transplant center in Georgia to transplant DCD hearts and lungs, we offer more hope to patients and their families.  

One breakthrough is machine perfusion, a tool that’s expanded the possibility of DCD transplant. In the past, predicting when a heart would stop was hard, making timing a challenge. Machine perfusion works as a pump, keeping the donor heart beating. This technology can preserve hearts longer, supporting their readiness for transplant. It can even revive, test and improve hearts outside the body before transplant.

This means physicians can confirm the heart is ready for transplant before contacting the patient. The result is fewer unnecessary hospital stays and a smoother, less stressful process for patients and their families.

“At Emory, we are dedicated to pushing the boundaries of what is possible in transplantation medicine,” says Dr. Daneshmand. “The advancements in machine perfusion and our commitment to utilizing DCD organs address the organ shortage crisis and dramatically improve patient outcomes. We are transforming lives and setting new standards in the field.”

Marwan Kazimi, MD, surgical director for the Emory Transplant Center’s liver transplant program, says wait times for organ transplants have significantly decreased with machine perfusion. “After five months of using machine perfusion, we were down from over a year to an average of two and a half weeks from listing to transplant."

Dr. Kazimi attributes Emory’s DCD program's success to modernization and collaboration.

"It's the willingness of the surgeons, hepatologists (specialists in liver, gallbladder and pancreas diseases), and physicians to push the envelope and explore," he says. "It's support from the administration. And it’s the excitement of our coordinators who work with patients to figure out the logistics.”

Emory Healthcare is working to expand the possibilities of the DCD program and heart transplant care. Researchers are diving into how machine perfusion impacts heart cells and molecules. Understanding these processes better can help broaden donor eligibility. This could raise the age limit for donors and make more hearts available for patients in need.

We’re also exploring how DCD technology could offer new options for cancer patients. Current research may bring new hope to patients with conditions like metastatic colorectal and bile duct cancers.