More organs are being donated after the heart stops, not brain death.
Policies are changing too
[February 27, 2026]
By LAURAN NEERGAARD
WASHINGTON (AP) — The vast majority of organ donations once came from
people who were brain-dead. Now they're increasingly coming from people
who died when their heart stopped beating, a major shift that can boost
transplants but also raises public confusion, researchers reported
Thursday.
What’s called donation after circulatory death, or DCD, jumped
dramatically in a short period: It accounted for 49% of all deceased
donors in the U.S. last year, up from 2% in 2000.
Technology has helped overcome barriers to using those organs — ways to
keep them from deteriorating as the heartbeat winds down — spurring this
type of donation at the same time the nation is hunting ways to overcome
a dire shortage. More than 100,000 people are on the transplant waiting
list and thousands die waiting. Just over 49,000 transplants were
performed last year.
But specialists from NYU Langone Health found donation after circulatory
death is far more common in some parts of the country than others. That
suggests better educating the public and local hospitals about the
option could further increase access to lifesaving transplants.
The findings, published in the medical journal JAMA, come as some rare
but scary reports of potential donors who showed signs of life have
shaken trust in the transplant system.
Additional safeguards are being developed by both federal officials and
the nonprofit organ procurement organizations, or OPOs, that the
government certifies to coordinate donation. The new findings may aid
that policymaking.
Donation after circulatory death is complex and “we need to make sure we
are doing it well,” said Dr. Babak Orandi, an NYU transplant surgeon and
study co-author. “If we stop doing it or severely restrict it, there
would be pretty significant repercussions for patients."
Different types of organ donation
While living donors can provide certain organs, most transplants are
thanks to donations from the deceased. Brain death is declared when
testing shows someone has no remaining brain function. If they're a
possible organ donor, the body is kept on a ventilator to support the
organs until they’re retrieved.
Donation after circulatory death can be an option if someone has a
nonsurvivable injury but all brain function hasn't ceased, and the
family chooses to end life support. Death occurs after the heart
gradually stops beating. Once that happens there's a mandatory wait —
five minutes, according to guidelines from the American Society of
Transplant Surgeons — to be sure it won't restart. Then the person's
doctor declares death.
By law, donation and transplant groups can’t participate in the decision
to end life support, and they’re not in the room when it’s withdrawn.
Organ retrieval cannot begin until death is declared. If death doesn’t
occur quickly enough, within about two hours, the organs aren’t usable
and retrieval isn’t attempted.
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 Variation in who donates
To track the donor evolution, the NYU team analyzed data from the
nation’s Organ Procurement and Transplantation Network, and from 55
OPOs that recover organs in assigned regions around the country.
Last year, circulatory death accounted for more than half the donors
at 24 organ donation agencies. But it varied widely, with some
accounting for as little as 11% of donors.
Hospital resources play a role, according to the Association for
Organ Procurement Organizations. Decisions to withdraw life support
are common, but small or rural hospitals may not be as familiar with
the extra steps involved with donation.
Another factor is whether hospitals have adopted that new
technology. The quality of organs can suffer as the heart stops,
briefly depriving them of oxygen. After death is declared, a tool
called normothermic regional perfusion allows surgeons to
temporarily restore that blood flow to organs in the chest or
abdomen — avoiding the brain — while they do the delicate work of
removing them.
It has helped enable use of organs from older, sicker donors after
their hearts stop. But even temporarily restoring blood flow after
death has raised ethical questions.
New policies for donation after circulatory death
The Health Resources and Services Administration is preparing new
national policies to improve safeguards for this type of donation.
One proposal would allow anyone involved with a potential donor who
questions if their condition is right for life-support withdrawal to
call for a pause in those preparations.
Other proposals would require OPOs to document that the hospitals
caring for the potential donor are performing appropriate
neurological exams, and to educate families of potential DCD donors
about the steps required.
The Association of Organ Procurement Organizations has some similar
guidelines and some OPOs already have created checklists to help
hospitals.
The group also urges withdrawing life support in the critical care
unit, not in an operating room, to help avoid public confusion about
when death occurs and when organ groups step in, said association
president Jeff Trageser.
Donation after circulatory death “requires a lot of buy-in from the
community, including the local hospitals, to make this happen,” said
NYU’s Orandi. “A couple of cases out of many, many cases has led to
a loss of trust.”
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