Heart transplant teams looking to save more lives with hearts from donors after circulatory death (DCD) now have clear data on what works best. A large review of United Network for Organ Sharing records covered 1,114 adult DCD heart transplants from 2019 to 2023 across 59 centers. 
Researchers grouped centers by total DCD hearts done: low at 10 or fewer, medium at 11 to 24, and high at 25 or more. They focused on one-year survival after transplant as the main measure, while controlling for other factors. The study was published in the Journal of Heart and Lung Transplantation. 
Volume Groups Show Survival Gaps
Low-experience centers hit 89.0% one-year survival, lagging behind high-volume ones at 92.9%—a gap that held up even after matching for donor type and center skill with standard brain-death donors. Medium centers fell in between. This edge came from DCD-specific know-how, not overall transplant busyness.
Learning Curve Tops Out at 20 Cases
The graph model traced a steady drop in death risk as centers passed more DCD hearts, with big gains up to 20 cases. After that point, survival leveled off, suggesting teams master the skills by then. Both perfusion methods, i.e., normothermic regional and direct, gave similar results across all groups.
Why Experience Drives Better Odds
DCD transplants differ from usual ones because the heart stops briefly before restart, demanding quick, precise steps. High-volume centers hone these through repetition, cutting early risks. The study adjusted for patient age, illness, and donor details to isolate experience effects.
Push for Smart Program Growth
These results back sending DCD hearts to practiced centers while urging more places to build skills safely. Leaders can aim for 20 cases to hit peak performance, helping expand this vital option without harm. For transplant doctors, it means team training, protocol sharing, and volume tracking to match top survival.