Organ donations have surged in the United States, partly thanks to improved harvesting methods

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"Organ donations have surged in the United States, partly thanks to improved harvesting methods.

Until recently, most organs came from donors who were brain dead but kept on life support, with their circulatory systems still functioning.

Over the past decade, however, advances in organ preservation and recovery have made it increasingly feasible to recover organs after circulatory death [DCD], when the heart has stopped and preservation becomes far more difficult.

A recent study finds that in 2000, just 2 percent of donors fell into this category;
by 2025, that had risen to 49 percent, with the number of such donors rising from 118 to 8,129."

"... Recent innovations have facilitated recovery from medically complex DCD donors.
Normothermic regional perfusion, in which perfusion is restored in situ to limited organs after circulatory death, contributed to the rise in recovery of DCD organs since its use began increasing in 2019.
The regulatory approval of normothermic machine perfusion for livers (2021) contributed to the subsequent acceleration of DCD liver recovery, and normothermic machine perfusion enabled the advent of DCD heart transplantation in 2019.” "

"... By contrast, donation after circulatory death involves donors who do not meet criteria for brain death and who cannot be kept alive without life support machines. In these cases, if the family chooses to stop life support, it is then given the option to do so in an operating room instead of the intensive care unit.
If the patient dies within a set time after support is removed, organs can be recovered and used for transplantation, preserving the opportunity to donate according to the wishes of the family and the patient. ..."

From the abstract:
"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. 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. 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."

Doomslayer: Progress Roundup

DCD Organ Donations Surge in the US

More Organ Donations Now Come from People Who Die After Their Heart Stops Beating (original news release) "As the Donor Pool Grows & More Lifesaving Transplants Become Possible, Public Education Is More Important Than Ever"

Changes in Organ Donation After Circulatory Death in the United States (open access)

DCD = donation after circulatory death, DBD = donation after brain death