The Johns Hopkins Comprehensive Transplant Center is the first institution in Maryland to perform heart transplants using donation after circulatory death (DCD) organs. The first Johns Hopkins DCD heart transplant took place April 28, 2024, with several additional operations since. All patients are recovering well.

Typically, hearts for transplant are procured after a donor has been declared brain dead, people with a complete loss of brain activity but whose hearts are still beating. Accepting organs from DCD donors — who have suffered a devastating neurologic injury but do not meet traditional brain death criteria — just after their heart stops, is a growing practice and can increase the donor pool by as much as 30%–75%, explains cardiothoracic surgeon Chetan Pasrija, who, with colleague Antonio Polanco, directed these first transplant operations. “This increases our access to really good hearts for our recipients and allows us to provide the highest quality care for our patients,” Pasrija says.

“The reason we didn’t do DCD heart transplantation 40 years ago is there was an assumption that if the heart stopped, it was no longer good,” he adds. “We more recently learned that we can resuscitate these hearts and open the donor pool for our patients.” Studies have indicated that these reanimated hearts perform just as well as those taken from brain-dead donors.

In the DCD process, a heart is procured after the donor is taken off life support and dies naturally. The organ is then perfused with solution either before or after removing it from the donor, placed in a special container to maintain quality and temperature, and quickly transported to Johns Hopkins for use.             

The 40-year-old recipient of the April 28 transplant had early onset of coronary artery disease resulting in severe weakening of his heart function. He had been waiting for a new heart for a year and a half before receiving a DCD heart.

“We were extremely pleased” to see the hearts beating in their new recipients, Polanco says. “We have taken on patients who have been turned down before, who are higher-risk individuals … I don’t think that you can be a top program and not offer the full gamut of technology and potential donors to your recipients. This is just the beginning.”

Some DCD organs, such as livers, have long been used at Johns Hopkins. The team comprehensively evaluated the process for DCD hearts — including their post-transplant success at other centers — before using them, says Kavita Sharma, director of heart failure and cardiac transplantation. Including the DCD procedures, Johns Hopkins surgeons performed 34 heart transplants between January and May, whereas a typical calendar year tops out at 20–25 such procedures.

She attributes the rapid growth in the program’s volumes over the past six months to several factors, including “increased surgical capacity and depth of experience with listing complex, higher risk patients and expanding our donor criteria including wider distance, age and comorbidity profile range, without compromising donor quality and function, and our newly activated DCD program.”

“We feel very confident that DCD donation is going to be one of the primary ways that patients are going to get heart transplants into the future,” Sharma adds.

On the horizon for the cardiac transplant team: moving to a newer FDA-approved perfusion device for donor hearts that perfuses the heart with oxygenated blood to keep it beating while being transported to the recipient.

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