Rapid Rise in DCD Donation Through 2025: What the JAMA Letter Reports

A JAMA research letter on donation after circulatory death (DCD) describes secular trends in DCD donation in the United States. The authors frame the analysis across the 2000–2025 time horizon as a description of donation patterns rather than an evaluation of clinical outcomes. In that descriptive scope, DCD is presented as shifting from a rare pathway to a large share of deceased donation over the period studied.

The authors add context on overall transplant reliance on deceased donation during 2018–2025, reporting that deceased donors accounted for most transplant activity for key organs in that interval. Examples cited include approximately 75% of kidney transplants and 94% of liver transplants, with all lung, heart, and pancreas transplants also using deceased donor organs. The letter also describes organ procurement organizations as federal contractors responsible for coordinating organ recovery and allocation in the US system, positioning DCD trends within that operational setting.

The associated abstract (geographic variation in DCD donation) accompanies the research letter describing secular DCD trends. In the letter’s background, organ procurement organizations (OPOs) are described as coordinating US organ recovery and allocation, and DCD recovery is characterized as operationally complex and time constrained. The discussion closes by emphasizing that variation in DCD growth is itself a relevant feature of the trend.

The letter also outlines constraints the authors describe as specific to the DCD pathway. They state that DCD organs carry a higher risk of organ dysfunction compared with organs from donation after brain death, and they note added recovery complexity, including that organ recovery may not be possible if the time from withdrawal of life support to circulatory death is prolonged. At the same time, the authors attribute rising interest in DCD transplantation to severe organ shortages and to technological innovations that may enhance DCD organ function, without framing the excerpted text as a modality-specific endorsement.

Overall, the research letter remains focused on describing national DCD donation trends. The background reiterates the role of OPOs and notes the time sensitivity that can limit DCD recovery when the withdrawal-to-circulatory-death interval is prolonged. The closing framing centers on how this shift in donation pathways intersects with procurement and preservation operations, while detailed implementation choices are not enumerated.

Key Takeaways:

• The authors describe a marked national shift toward a larger share of DCD among deceased donors over 2000–2025.
• The letter reports geographic variation in the rise of DCD donation and links that variation to differences in implications for supply, recovery logistics, and preservation practice.
• The authors describe constraints (including dysfunction risk and recovery challenges when the withdrawal-to-circulatory-death interval is prolonged) alongside drivers of interest (organ shortages and technological innovations that may improve DCD organ function).