1 Introduction

This Deceased Organ Donation chapter describes the epidemiology of deceased organ donation over the past decade and deceased donor metrics, as well as data on organ disposition in 2024. The donor metrics described in this chapter include organs recovered per donor, organs transplanted per donor, and nonuse rate. Each of these metrics is defined below.

2 Donors and Organs

In 2024, the overall count of deceased donors increased to a record high of 16,989, a 4.0% increase from the 16,335 the year before. This continues the trend of an increasing number of donors annually and represents a near doubling of the deceased donors since 2013 (8,268) (Figure DD 1). In 2024, for the first time since at least 2013, there has been a decline in the number of DBD donors compared with the previous year. In 2024, there were 9,705 DBD donors, a 7% decline from the previous year. Thus, the increase in donors in 2024 was from DCD donors. In 2024, there were 5,768 DCD donors without normothermic regional perfusion (NRP), a 5.5% increase from 5,463 in 2023. In 2024, there were 1,237 DCD donors with NRP–method unknown (ie, NRP used but method unknown), a 397% increase from the 249 such donors in 2023 (Figure DD 2). In addition, in 2024, there were 279 donors with thoracoabdominal NRP (TA-NRP), a 53% increase from 182 in 2023. Note that advanced organ preservation utilization and process data are not systematically or consistently collected or reported to the Organ Procurement and Transplantation Network (OPTN). Consequently, OPTN data do not permit the assessment of which organs are preserved using normothermic machine perfusion (NMP) or NRP, the outcomes of these preservation technologies, or the frequency with which donor patients have attempted or actual NRP organ recovery performed. The data included in this Annual Data Report assume that NRP was performed if and only if the time from declaration of death to cross-clamp for a DCD donor was greater than 30 minutes.

The record number of donors was accompanied by record numbers of organs authorized, organs recovered, and organs transplanted, all of which have increased annually since 2013. In 2024, the number of organs recovered increased to 62,112, a 5.0% increase from 59,121 in 2023. The number of organs transplanted rose to 42,048 in 2024, a 3.5% increase from 40,614 in 2023 (Figure DD 3).

3 Organs Recovered Per Donor

In 2024, the ORPD for all organs was 3.35, a 1.4% increase from 3.31 in 2023. Since each donor can potentially donate two kidneys and they typically go to two recipients (as for lung, if both are recovered they count as two recovered organs, but in lung they typically go to the same recipient), the organ-specific ORPD remained highest for kidneys at 1.87 in 2024, a 1.1% decline from 2023. The ORPD for kidneys has been relatively stable since 2013 (range since then, 1.80-1.90) (Figure DD 4). In 2024, from 16,428 donors, 896 left kidneys and 874 right kidneys were not recovered. The most common reasons for nonrecovery were diseased organ, donor medical history, and poor organ function (Figure DD 22 and Figure DD 23).

The ORPDs for pancreas, intestine, and heart have declined slightly over the past decade, whereas ORPDs for liver and lung have increased slightly (Figure DD 5). In 2024, from 16,989 donors, 12,228 pancreata were not recovered. The most common reasons were organ refused by all national programs, donor medical history, and poor organ function (Figure DD 25). From the 16,989 donors, 3,908 livers were not recovered, with the most common reasons being organ refused by all national programs, ruled out after evaluation in operating room, and diseased organ (Figure DD 26); 15,908 intestines were not recovered, most commonly because the organ was refused by all national programs, poor function, or “Other” reason (Figure DD 27). In 2024, from the 16,989 donors, 9,893 hearts were not recovered, with the most common reasons being poor organ function and donor medical history (Figure DD 28); 11,569 lungs were not recovered, with the most common reasons being poor organ function and organ refused by all national programs (Figure DD 29).

The ORPD for all organs varies by DSA and in 2024 ranged from 2.60 to 3.81. Because the ORPD is an unadjusted number, it does not account for mix of donor types (including young, old, DBD, and DCD), which explains some of the differences seen between DSAs (Figure DD 6).

4 Organs Transplanted Per Donor

The number of organs transplanted increased to 42,048 in 2024, from 40,614 in 2023 (Figure DD 3). However, the OTPD for all organs has continued to decline to 2.66 in 2024, from 3.08 in 2013. Again, because each donor can potentially donate two kidneys which typically go to two recipients, the organ-specific OTPD remained highest for kidneys at 1.32 in 2024, the lowest value during that period and down slightly from 1.36 in 2023. This OTPD was highest in 2019 at 1.50 (Figure DD 7).

The OTPD for kidneys varies by kidney donor profile index (KDPI), and the OTPD values by KDPI category have been stable since 2013. In 2024, the OTPD for kidneys was 1.93 for the least medically complex kidneys (defined as KDPI of less than 20%). For kidneys with KDPIs of 20-<35%, 35-<85%, and 85% or greater, the OTPDs were 1.87, 1.47, and 0.57, respectively (Figure DD 17). The percentage of deceased donors with KDPI of 85% or greater varies across OPOs and ranged from 4.0% to 21.5% in 2024 (Figure DD 21). In 2024, the OTPD for kidneys from DCD donors with TA-NRP was 1.78, higher than the OTPDs from DBD donors, DCD donors without NRP, and DCD donors with NRP–method unknown: 1.40, 1.19, and 1.16, respectively (Figure DD 11).

In 2024, the OTPD for pancreas was 0.050, an 11.1% decrease from 0.056 in 2023. Since 2013, the pancreas OTPD has decreased annually (Figure DD 8). In 2024, the OTPD for pancreata from DBD donors was 0.08, higher than the OTPDs from DCD donors without NRP, DCD donors with TA-NRP, and DCD donors with NRP–method unknown: 0.0045, 0.029, and 0.0008, respectively (Figure DD 12).

The OTPD for liver was 0.63 in 2024, a 4.5% increase from 0.61 in 2023. This increase in liver transplants per donor is likely a result of increased use of advanced preservation such as NRP and NMP. Prior to 2023, the OTPD for liver had typically decreased every year, and the lowest liver OTPD in the past decade was 0.59 in 2022 (Figure DD 8). In 2024, the OTPD for liver from DBD donors was 0.79, higher than the OTPDs from DCD donors without NRP, DCD donors with TA-NRP, and DCD donors with NRP–method unknown: 0.37, 0.76, and 0.57, respectively (Figure DD 13).

The OTPD for intestine was 0.0057 in 2024, similar to 0.0058 in 2023. The OTPD for intestine has declined since 2013, when it was 0.013 (Figure DD 8). The intestines transplanted were all from DBD donors (Figure DD 14).

The OTPD for heart was 0.27 in 2024, almost matching the 0.28 in 2023 (Figure DD 8). In 2024, the OTPD for heart from DBD donors was 0.40, lower than the OTPD of 0.94 from DCD donors with TA-NRP and higher than the OTPD of 0.09 from DCD donors without NRP (Figure DD 15). Thus, as with kidney, the OTPD for heart from DCD donors with TA-NRP was the highest among all other types of heart donors.

The OTPD for lung was 0.37 in 2024, a 6.3% increase from 0.35 in 2023 (Figure DD 8). This increase in lung transplants per donor is likely from increased use of NRP. In 2024, the OTPD of lungs from DBD donors was 0.56, higher than the OTPDs from DCD donors without NRP, DCD donors with TA-NRP, and DCD donors with NRP–method unknown: 0.12, 0.35, and 0.04, respectively (Figure DD 16).

The OTPD for all organs combined varies by OPO and in 2024 ranged from 1.94 to 3.17 (Figure DD 9). The OTPD also varies by donor status. In 2024, the OTPD for all organs from DBD donors was 3.26, higher than the OTPDs of DCD donors without NRP and DCD donors with NRP–method unknown at 1.79 and 1.78, respectively, but lower than that of DCD donors with TA-NRP at 3.86 (Figure DD 10). The percentage of DCD donors varies across DSAs and in 2024 ranged from 0.8% to 62.3% (Figure DD 19). The percentage of DCD donors with NRP (includes TA-NRP) across DSAs ranged from 0% to 35.2% and reflects the increasing use of NRP and TA-NRP among DCD donors (Figure DD 20).

5 Organs Recovered for Transplant but Not Transplanted

In 2024, there were 11,244 organs recovered for transplant but not transplanted (ie, nonuse), an 11.5% increase from 10,085 in 2023. These unused organs represent 20.7% of all organs recovered combined in 2024, a percentage that has increased annually since 2018. The percentage of nonuse varies by organ. In 2024, kidney had the highest percentage of nonuse (29.3%), followed by pancreas (25.1%), liver (11.5%), lung (11.3%), intestine (4.9%), and heart (1.9%) (Figure DD 18); by their numeric values, 4,425 left kidneys, 4,506 right kidneys, 172 en bloc kidneys, 284 pancreata, 1,401 livers, 5 intestines, 88 hearts, and 363 lungs were not used.

6 Organs Transplanted

In 2024, from 16,428 deceased kidney donors, 10,918 left kidney transplants and 10,849 right kidney transplants were performed (Figure DD 22 and Figure DD 23). From 561 en bloc kidney donors, 322 en bloc kidneys were transplanted (Figure DD 24).

In 2024, from 16,989 deceased donors, 878 pancreata were transplanted, including 31 that were transplanted as islets. Interestingly, 3,243 pancreata were recovered for research, of which 1,180 were sent for non–islet cell research, 2,010 were accepted for islet cell research, and 53 were not used (Figure DD 25). Pancreas was the most common organ that was recovered for research.

In 2024, from 16,989 deceased donors, 10,773 livers were transplanted (Figure DD 26), 97 intestines were transplanted (Figure DD 27), and 4,623 hearts were transplanted (Figure DD 28).

In 2024, from 16,989 deceased donors, 3,334 lungs were transplanted (Figure DD 29). Lungs were the most common organ exported out of the United States and transplanted in 2024 (64 lungs).

7 Change in Characteristics of Donors Over the Past Decade

Since 2014, there has been an increase in the use of organs from donors with higher KDPI kidneys. In 2024, 27.7% of donors had a KDPI of 85% or greater, up from 15.3% of donors in 2014. Consistent with this trend, in 2024 there was a decline in the percentage of donors with a KDPI of less than 20% compared with 2014. There was also an increase in the use of human immunodeficiency virus–positive (nucleic acid test) donors, donors aged 65 years or older, and DCD donors with and without NRP (Table DD 1).

Donor mechanisms of death have changed during this period. Drug intoxication as mechanism of death increased to 12.2% in 2024, from 7.3% in 2014. Cardiovascular mechanism of death also increased: 23.8% in 2024 versus 16.8% in 2014. In contrast, gunshot wound, blunt injury, and stroke decreased as mechanisms of death in 2024 compared with 2014. Regarding donor circumstances of death, non–motor vehicle accident (non-MVA) increased to 16.2% in 2024, from 11.5% in 2014, and natural causes increased to 55.1% in 2024, from 44.6% in 2014. In contrast, MVA, suicide, and homicide decreased as circumstances of death (Table DD 2).

Anoxia as cause of death increased to 47.9% in 2024, from 33.7% in 2014; stroke and head trauma decreased (Table DD 2). The circumstances of death among donors with head trauma as cause of death reveal that non-MVA increased to 26.0% in 2024, from 22.5% in 2014 (Table DD 3). The characteristics of deceased donors when combining circumstance and mechanism of death have changed over the past decade. Non-MVA by drug intoxication increased to 8.1% in 2024, from 2.0% in 2014; natural causes by cardiovascular increased to 20.6% in 2024, from 12.3% in 2014. In contrast, MVA with blunt injury, homicide by gunshot wound, and natural causes by stroke decreased (Table DD 4).