Temporal changes in the recovery and utilization of kidneys donated after circulatory death in the United States

Kidneys from donation after circulatory death (DCD) donors historically had lower recovery and utilization than kidneys from donation after brain death (DBD) donors. However, the organ shortage and advances in organ preservation have increased interest in DCD transplantation. We used Organ Procurement and Transplantation Network data to study temporal changes in US DCD kidney recovery and transplantation. The percent DCD among kidney donors increased from 21.0% (era 1, 2016-2019) to 30.6% (era 2, 2020-2022) and 42.4% (era 3, 2023-2025). By 2025 quarter 2, more than half (50.4%) of kidney donors were DCDs. Wide variability persisted across eras in percent DCD by recovering Organ Procurement Organization (era 1 range, 0%-38%; era 2 range, 0%-49%; and era 3 range, 0.4%-60%) and by transplanting center (era 1 range, 0%-48%; era 2 range, 0%-58%; and era 3 range, 0%-60%). Transplanted DCD kidneys in era 3 (vs era 1 and era 2) were more often from donors aged >60 years with diabetes, hypertension, obesity, and death due to cardiovascular disease or stroke; 86.8% were pumped. Though the recovered DCD kidney nonuse rate rose from 20.8% (era 1) to 29.9% (era 2) and 35.4% (era 3), nonused DCD kidney donors were older and had more comorbidities in era 3 compared with earlier eras. Given that half of kidney donors are now DCD, refinements in DCD donor selection and management are needed to optimize recovery and utilization.