Kidney Utilization in the Context of a Shifting Donor Landscape in the United States

Background. In 2021, 24.6% of kidneys procured in the United States were not utilized. This study examines trends in kidney graft nonutilization within the context of shifting donor demographics and procurement practices. Methods. We analyzed data from the Standard Transplant Analysis and Research data set, spanning deceased donors from 1988 to the present, provided by the Organ Procurement and Transplantation Network. Linear regression was used to estimate changes in organ utilization over time. Results. During the past 40 y, the quality of donor kidneys decreased as measured by the mean Kidney Donor Risk Index (KDRI), which increased from 1.20 to 1.43. Currently, 13% of kidneys procured have a KDRI >2, with an 81% nonutilization rate. Despite the increase in high-risk graft procurement, the overall growth in kidney recoveries and utilization has increased. Conclusions. The volume of kidney transplants has grown alongside an increasing KDRI in the donor population, which led to a concurrent rise in nonutilization rates. Nevertheless, transplant volumes and 1-y graft outcomes have shown continuous improvement, underscoring the resilience of the transplantation system despite the evolving donor landscape.