Rapid recovery with extended ultraoxygenated preservation (REUP) for donation after circulatory death (DCD) was found to be feasible regardless of donor age and ischemic time, according to a study published Jan. 26 in JAMA.

The study included 24 REUP-recovered DCD transplants (38% of donors ≥40 years; 50% of recipients had prior sternotomy) from a single high-volume transplant center from November 2024 to July 2025, with 60% of donor hearts having an ischemic time longer than 4 hours. Aaron M. Williams, MD, et al., assessed severe primary draft dysfunction, 30-day survival and acute rejection on first endomyocardial biopsy, to determine feasibility of the REUP technique in adult transplant patients.

The 30-day survival rate was 96%. Severe primary graft dysfunction was observed in one patient (4%) and secondary graft dysfunction in one other patient (4%). Acute cellular rejection grade 2R was noted in one patient (4%) on first endomyocardial biopsy, but no antibody-mediated rejection was reported.

"This study highlights that REUP is easy to deploy across a broad range of donor ages and without regard to ischemic time, thereby removing geographic constraints and avoiding preimplant cardiac reanimation," state the authors.

In a related perspective article, Michael J. Young, MD, MPhil, and Christof Koch, PhD, outline ethical considerations for consciousness, withdrawal of life-sustaining treatment and controlled donation after circulatory determination of death. "Recent events have exposed operational gaps that can be addressed without diminishing the immense good that organ donation achieves," they write.