Changing Landscape of Procurement of Deceased Donor Organs: An Analysis of National Trends

BACKGROUND: Donation after circulatory death (DCD) has historically been underutilized compared with donation after brain death (DBD). Advances in preservation strategies and policy reforms have accelerated DCD adoption, raising the potential for meaningful shifts in the US donor pool. METHODS: We analyzed national donor trends using Scientific Registry of Transplant Recipients (SRTR) Explorer data from 2015 to 2025. Donor type (DCD vs. DBD) was evaluated across organ types and organ procurement organizations (OPOs). Temporal trends were assessed and crossover intervals were identified. RESULTS: We identified an interval in which the 30-day rolling donor count for DCD exceeded that of DBD for the first time (May 18 and June 18, 2025). During this period, DCD accounted for 52% of kidney, 44% of liver, and 26% of heart and lung recoveries. In 2025, DCD increased by 2.7 donors per day while DBD declined by 0.6 per day (p < 0.001). Over the past decade, DCD growth outpaced DBD nearly threefold, with kidney and lung showing the steepest increases. Both high- and low-volume OPOs demonstrated upward trends. Since reporting began in 2023, use of normothermic regional perfusion has expanded steadily. CONCLUSIONS: This analysis identifies an interval in which the 30-day rolling donor count for DCD exceeded that of DBD, reflecting a notable shift in donor-availability trends. These findings underscore the need for standardized practices to ensure equitable allocation and minimize organ discard as reliance on DCD continues to grow.