*Purpose: Donation after circulatory death (DCD) heart donation is increasingly common in the US. The two methods for DCD heart donation are normothermic regional perfusion (TA-NRP) and cold flush with ex-vivo heart machine perfusion (CF-MP). Liver and kidney transplant outcomes after TA-NRP DCD have shown promise outside the US but have not been reported in the US.

*Methods: All successful DCD heart donors from October 1, 2020 to September 30, 2021 were identified in the UNOS Star file database. Death to cross-clamp time was used to distinguish between TA-NRP DCD donors (>15 minutes) and CF-MP DCD donors (<15 minutes). Groups were compared with bivariate analysis.

*Results: Other than death to cross-clamp time, donor characteristics were similar among the two donor groups except CF-MP donors had a higher median age (31 vs 27) and kidney donor profile index (29% versus 19%). The delayed graft function rate for CF-MP donors was higher than TA-NRP donors (42.9% versus 12.5%). There were no significant differences in liver transplant recipient outcomes. 2 liver recipients of CF-MP DCD donors had early graft failures requiring re-transplantation versus none of the TA-NRP DCD recipients. No ischemic cholangiopathy was reported in either group.

*Conclusions: We found that the rates of delayed kidney graft function were significantly higher with CF-MP DCD donors as compared to TA-NRP DCD donors ad that two of the CF-MP recipients required early re-transplantation as compared to none of the TA-NRP recipients. Longer term follow-up is needed to determine if there are differences in biliary complication rates, especially ischemic cholangiopathy.

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