The gap between transplantable kidneys and patients who actually receive them remains one of transplant medicine's most pressing inefficiencies — and the latest national data reveal that closing it is proving stubbornly difficult even as procedural volumes reach historic highs. In 2024, the United States performed 27,660 kidney transplants, a record number driven chiefly by growth in deceased-donor procedures. Yet the waiting list expanded in parallel, with nearly 144,000 adult candidates listed and more than one in ten waiting five years or longer — a statistic that underscores how supply growth has not kept pace with demand recovery after the pandemic period.
The data highlight a striking paradox at the heart of deceased-donor kidney utilization: while transplant counts rose, the proportion of recovered deceased-donor kidneys that were ultimately not transplanted climbed to 29.3%. The discard problem is especially acute for older and higher-risk organs — kidneys from donors aged 65 or older were not transplanted at a rate approaching 69%, and those with a kidney donor profile index at or above 85% showed similar non-use. Biopsied kidneys, often reflecting clinical uncertainty about organ quality, were discarded more than 40% of the time. One area of genuine progress was hepatitis C virus-positive donors, where non-use rates have declined substantially — a reflection of effective direct-acting antiviral therapy normalizing HCV-positive organ acceptance. A meaningful equity signal also emerged: transplant counts increased across Black, Hispanic, Asian, and Multiracial recipients, partly attributable to a 2023 policy correction that addressed waiting-time disadvantages created by race-inclusive kidney function estimates.
These figures collectively challenge the assumption that record transplant volumes signal a well-functioning allocation system. The persistently high discard rates for marginal-criteria kidneys suggest a risk-aversion culture among transplant programs — potentially shaped by outcomes-based center metrics that penalize poor graft performance. Research consistently shows that many discarded high-KDPI kidneys, if transplanted, would still offer survival benefit over continued dialysis. This annual report is observational and descriptive by nature, limiting causal inference, but its population-scale breadth makes it one of the most reliable benchmarks in transplant medicine.