Nearly three in ten recovered kidneys are never transplanted — 11,244 organs went unused in 2024

What is happening?

In 2024 the United States recovered organs from 16,989 deceased donors and performed 46,750 solid organ transplants. In the same year 11,244 organs were recovered for transplant and then not transplanted — an 11.5 percent rise from 10,085 in 2023, and 20.7 percent of all organs recovered combined, a share the annual data report says has increased every year since 2018.

Kidneys carry most of it. 29.3 percent of recovered kidneys were not transplanted in 2024, against 18.2 percent in 2013. That is 9,103 kidneys — 4,425 left, 4,506 right and 172 recovered en bloc — taken from consented donors, offered through the match system, and then thrown away.

Through 2024 the number of donors was going up and the yield per donor was going down. Organs transplanted per deceased donor fell to 2.66 in 2024 from 3.08 in 2013.

Whose problem is this?

The body that recovers an organ does not decide whether it is used, and the program that decides is not measured on what happens to the offers it turns down.

Where does this problem end?

The boundary matters because the loss is not a shortage of willing donors. Consent was already given and the organ was already removed before the failure happened.

What is the state now, and what should it be?

Now

What it should be

Needs a new measurementno official target for the nonuse rate appears in any document opened for this entry. CMS certifies organ procurement organizations against a donation rate and a transplantation rate under a three tier rule, and the OPTN grades transplant programs on offer acceptance and on survival after transplant, but none of the sources read here names a level that the share of recovered and unused organs is supposed to reach.

How big is it?

The affected population used here is the people waiting. In 2024, 167,230 unique patients were on a waiting list for a solid organ transplant in the United States, with 70,600 added during that year. At the start of 2026 more than 100,000 people were waiting at any one time.

Those two figures answer different questions. The larger one counts everybody who appeared on a list at any point in a calendar year and the smaller one counts everybody on a list on a single day, so the width of that range is the gap between annual prevalence and point prevalence rather than a margin of error.

The annual harm is a separate and smaller number: 11,244 organs recovered and not transplanted in 2024, of which 9,103 were kidneys. Those are organs and not people — kidneys recovered en bloc go to one recipient — so the count of transplants forgone is somewhat below the count of organs.

Under what conditions does it arise?

1. Two scorecards held by two different parties. CMS measures each organ procurement organization on a donation rate and a transplantation rate under a three tier rule in which the lowest tier is decertified. The OPTN measures each transplant program on offer acceptance and on how its recipients do afterwards. Neither party is graded on the joint outcome, which is whether a recovered organ reaches a person. 2. Refusing an offer costs the refuser nothing that its own numbers will show. A study of 193 adult transplant centers covering 2021-04 to 2023-12 found that kidneys the authors classed as suboptimal were refused by a median of 9 centers, against a median of 5 refusals for the other kidneys. 3. The donor pool has been shifting toward donation after circulatory death. An analysis published by a donation and transplantation trade body in 2023 puts that share at 25 percent of all donations in 2020 and 35 percent in 2023, and reports that the count of recovered kidneys that were not usable more than doubled over the previous four years. Of the 16,989 deceased donors in 2024, 7,284 were donation after circulatory death. 4. The rule that would remove the weakest performers has not landed yet. CMS issued a proposed rule under docket CMS-3409-P on 2026-01-28 and took comments to 2026-03-31; a law firm reading of that rule published on 2026-02-13 reports that CMS has previously estimated that roughly half of all existing organ procurement organizations would not qualify for automatic recertification.

Every one of these conditions is defensible on its own terms and none of them requires anybody to behave badly. That is what makes the state stable rather than scandalous.

What has been tried?

The attempts sit on both sides of the gap. One set pushes recovery up and another set grades what programs accept, and no source read here reports a measured fall in the nonuse rate that follows any of them.

What was found?

Why is it still unsolved?

Incentive inversion — two scorecards, held by two different parties, and neither one is scored on whether a recovered organ reaches a person.

An organ procurement organization is certified by CMS against a donation rate and a transplantation rate, and under the three tier rule the lowest tier is decertified. CMS has estimated that roughly half of the existing organizations would not qualify for automatic recertification and would have to compete to retain their service areas. All of the pressure on that side of the handoff runs toward finding donors and recovering organs.

The other side is not unmeasured, and that is the part worth saying plainly. The OPTN added an offer acceptance metric for transplant programs and released it in 2023-07, so refusals are watched. What happened next is that nonuse rose 11.5 percent, from 10,085 organs in 2023 to 11,244 in 2024. The same scorecard also carries survival after transplant, and the two halves pull against each other — an accepted marginal organ that fails is written into the outcome a program is judged on for years, while a refusal is a line in a monitoring report that no patient outcome ever contradicts.

The researchers who measured 193 adult centers from 2021 to 2023 found suboptimal kidneys refused by a median of 9 centers against 5 for the rest. They report that substantial variation between centers continued under the kidney allocation policy that launched in 2021, so changing how an organ is offered did not by itself narrow the spread in what programs will take. Those same authors suggest that the recent removal of survival rate metrics from the conditions of participation of Medicare might help mitigate risk aversion, which is a hope they state for the future rather than a result they measured.

Both sides are behaving rationally and the joint result is the number in the title. Recovery went up, refusals went up alongside it, and organs transplanted per deceased donor fell from 3.08 to 2.66 through 2024. Nobody in the chain is graded on the distance between those two movements, which is exactly where the failure sits.

What observation would mean it is solved?

Candidates — (a) the kidney nonuse rate falls back toward the 18.2 percent of 2013 (b) organs transplanted per deceased donor rises back toward 3.08 (c) the absolute count of organs recovered and not transplanted falls below 11,244 and keeps falling.

(a) is a ratio and the cheapest way to improve a ratio is to shrink its denominator. If procurement bodies stop recovering marginal kidneys the rate improves while fewer people are transplanted.

(b) moves with the donor mix. Younger and healthier donors yield more organs each, so this can rise without a single acceptance decision changing.

(c) can be satisfied by a smaller system. Deceased donors already fell 2.5 percent in 2025, so an absolute drop in unused organs during that year would say nothing on its own. Read all three next to the donor count and the transplant count, or a shrinking system will read as a fixed one.

What is it connected to?

Fills with researchdialysis capacity and cost, the allocation policy changes of the OPTN, organ preservation and perfusion technology, and xenotransplantation all plausibly bear on this. Relation type and evidence grade were not established in this round.

What these sources do not say

• The arithmetic on the source page does not close. The annual data report states 62,112 organs recovered in 2024 and 42,048 transplanted, and separately states 11,244 recovered but not transplanted, which it calls 20.7 percent of all organs recovered combined. Those three figures cannot share one denominator. Recovery for research is part of the gap — the same chapter notes 3,243 pancreata recovered for research in 2024 — but it does not close the whole difference, and the chapter does not define the terms apart. This entry therefore leans on 11,244 and 20.7 percent and does not print a subtraction.
• Organs that were never recovered are not counted anywhere here. The report covers organs recovered and then unused. Consented donors whose organs were never recovered at all sit outside it, so the number of transplants the system failed to produce is larger than 11,244 by an amount none of these sources states.
• There is no state or regional breakdown. Certification runs by donation service area, which is the unit CMS acts on, yet no document opened here reported nonuse by area or by state alongside a national total.
• There is no 2025 nonuse figure yet. Donation and transplant counts for 2025 are published, but the nonuse rate is only available through 2024, so whether the trend continued through the year in which donation fell is unknown.
• Nobody counts the deaths this causes. Waiting list deaths are reported by year, but no document opened here connects a specific unused organ to a specific death, and the question of who would have received the 11,244 organs is not modeled in anything read for this entry.
• The findings behind the 2025 oversight hearing were not read. The date and subject of the hearing are confirmed; the federal investigation material that prompted it was not reachable.

See the evidence

Two chapters of the annual data report were read directly on the registry site of the SRTR; the kidney chapter of the same report could not be loaded. The kidney nonuse rate of 29.3 percent for 2024 appears in both the overview chapter and the deceased organ donation chapter and matches across them, and the kidney count of 9,103 equals 4,425 left plus 4,506 right plus 172 en bloc, which is the one place where the reported figures reconcile exactly. Federal pages at hrsa.gov, hhs.gov and house.gov returned HTTP 403 to every request in this session, so the regulatory items above rest on law firm summaries rather than on the rule text, and the findings of the 2025 federal investigation were not read at all. For the same reason the committee and the subcommittee that held the hearing of 2025-07-22 are confirmed from a transplant network page rather than from the announcement of the committee itself. Where a figure appeared only in a search summary and could not be opened, it was left out of this entry entirely.

People affected

Estimated range 100,000–167,230 As of 2024 to 2026-01

Sensitivity The width of this range is not a confidence interval. It is the gap between point prevalence and annual prevalence: the low value counts everybody waiting on one day, the high value counts everybody who appeared on a list at any point in a calendar year, so anyone listed and then transplanted, deceased or removed during 2024 shows up only in the high value. The two bounds also come from different years, 2026-01 and 2024, because no single source read here reports both measures for the same year. Two limits run in opposite directions. Upward: nonuse also lands on donor families who consented and produced no transplant, and organs from consented donors that were never recovered at all sit outside the reported nonuse figure entirely, so the population touched by the failure is wider than the waiting list. Downward: not every candidate on a list would have been a match for one of the 11,244 organs recovered and not transplanted in 2024, so the number of people whose wait was actually lengthened by nonuse is smaller than either bound and was not derived here.

Regional breakdown Certification of organ procurement organizations runs by donation service area, but every nonuse and waiting list figure opened for this entry is national. No document read here gave nonuse counts or waiting list counts by state or by donation service area alongside a national total, so no measured breakdown could be assembled. Splitting the national figure by state population would be proportional allocation, which has no basis here because transplant centers, listing practice and donation service area boundaries are all distributed unevenly with respect to population.