OPTN/SRTR 2023 Annual Data Report: Introduction

David P. Schladt¹, Ajay K. Israni^1,2

¹Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN

²Department of Medicine, University of Texas Medical Branch, Galveston, TX

Abstract

The OPTN/SRTR 2023 Annual Data Report presents the status of the solid organ transplant system in the United States from 2012 through 2023. Organ-specific chapters are presented for kidney, pancreas, liver, intestine, heart, and lung transplant. Each organ-specific chapter is organized to present waitlist information, donor information (both deceased and living, as appropriate), transplant information, and patient outcomes. Data pertaining to pediatric patients are generally presented separately from the adult data; however, many chapters now have a Donation section, which includes data on adult and pediatric organ donation. The data presented in the Annual Data Report are descriptive in nature. In other words, most tables and figures present raw data without statistical adjustment for possible confounding or changes over time. Therefore, the reader should keep in mind the observational nature of the data when attempting to draw inferences before trying to ascribe a cause to any observed patterns or trends. This introduction provides a brief overview of trends in candidates on the waiting list, new additions to the waiting list, transplant activity, and posttransplant patient survival, with a focus on 2013-2023. More detailed descriptions can be found in the respective organ-specific chapters.

Keywords: Organ transplant, patient survival, waiting list

1 Trends in Kidney Transplant

In 2023, there were 144,842 adult and pediatric candidates on the kidney waiting list at some point (Figure INT 1), a 1.3% increase from 2022. This includes active and inactive candidates on the list at any time during the year. Over the past decade (2013-2023), the size of the waiting list peaked prior to the COVID-19 pandemic, with 146,637 candidates in 2019. The number of new candidates added to the kidney waiting list in 2023 rose to 47,838 (Figure INT 3), a 5.6% increase from 2022. A similar increase was seen in the previous year. Over the past decade, the highest number of new kidney candidates were added in 2023. The number of kidney transplants also increased to 28,142 in 2023, the highest number and a 7.0% increase from 2022 (Figure INT 5). Despite the growing number of kidney transplants, there is potential for an even higher number of kidney transplants to be performed, based on the increasing proportion of kidneys from deceased donors recovered for the purpose of transplant but ultimately not transplanted (ie, nonuse rate). In 2023, the nonuse of kidneys increased to 27.9%, from 26.6% in 2022 (Figure INT 7). These kidneys when recovered en bloc were counted once, whereas kidneys recovered separately were counted twice. With over a quarter of all deceased donor kidneys not used, this represents an opportunity for improved efficiency in the transplant system. Among kidney transplant recipients in 2016-2018, 1-year and 5-year patient survival were 97.4% and 86.6%, respectively (Figure INT 8). Of note, a record number of donation after circulatory death (DCD) kidneys were transplanted in 2023—representing 26.1% of all deceased donor kidney transplants (Figure INT 9).

2 Trends in Pancreas Transplant

Over the past decade, the demand for pancreas-alone transplant has continued to decline, as evidenced by a decrease in the number of candidates listed for pancreas-alone or pancreas-after-kidney transplant. The number of these candidates was down to 974 in 2022 and 1,024 in 2023, compared with 1,536 in 2013 (Figure INT 2), which is likely due to improvement in medical management of diabetes. In comparison, the number of candidates waiting for a combined kidney-pancreas transplant over the same period has increased slightly to 3,554 in 2023, a 6.3% increase from 3,344 in 2022 and up from 3,428 in 2013. Similar trends were seen in the number of new additions to the pancreas waiting list in 2023, with an increase to 323 for pancreas-alone or pancreas-after-kidney and an increase to 1,587 for kidney-pancreas, compared with 2022 (Figure INT 4). The total number of pancreas transplants performed in the United States was 915 in 2023, a slight decline from 918 in 2022 (Figure INT 6). The proportion of pancreases from deceased donors recovered for the purpose of transplant but not transplanted declined to 23.4%, a decrease from 28.7% in 2022. Among all organs, pancreas still has a high nonuse rate, second only to kidney in 2023 (Figure INT 7). Thus, there is potential for an even higher number of pancreas transplants to be performed. Among transplant recipients in 2016-2018, 1-year and 5-year patient survival were 96.0% and 88.3%, respectively (Figure INT 8).

3 Trends in Liver Transplant

Over the past decade, the demand for liver transplants has continued to decline, likely due to improvements in the treatment of hepatitis C. In 2023, the number of adult and pediatric liver transplant candidates on the waiting list rose slightly to 25,634, a 1.2% increase from 2022. However, compared with 2013, the total number of candidates remained low, from a peak of 28,484 in 2013 (Figure INT 1). There has been a smaller increase in new candidates added to the waiting list during the same time period. In 2023, there were 14,658 candidates added to the waiting list, a 7.8% increase from 2022 (Figure INT 3). The number of liver transplants rose to 10,659 in 2023, an 11.9% increase from 2022; this number has increased each year since 2013, when it was 6,455 (Figure INT 5). The proportion of livers from deceased donors recovered for the purpose of transplant but ultimately not transplanted decreased to 9.7% in 2023, from 9.9% in 2022 (Figure INT 7). Thus, there is potential for an even higher number of liver transplants to be done. Among transplant recipients in 2016-2018, 1-year and 5-year patient survival were 92.5% and 81.5%, respectively (Figure INT 8). Of note, a record number of DCD livers were transplanted in 2023—representing 15.9% of all deceased donor liver transplants (Figure INT 9).

4 Trends in Intestine Transplant

In 2023, there were 349 candidates on the intestine waiting list, a slight increase from 347 in 2022 (Figure INT 2). Of these 349 candidates, 135 were newly added to the intestine waiting list (Figure INT 4). The number of intestine transplants in 2023 was 95, a 15.8% increase from 2022 (Figure INT 6). However, the demand for intestine transplants has largely continued to decline over the past decade, likely due to improvements in medical management. Among intestine transplant recipients in 2016-2018, 1-year and 5-year survival were 81.1% and 62.2%, respectively (Figure INT 8). This represents the lowest 1-year patient survival among all solid organ transplants.

5 Trends in Heart Transplant

In 2023, there were 9,190 candidates on the heart waiting list, a 5.5% increase from 2022 (Figure INT 2). Of these candidates, 5,800 were newly added to the list in 2023, which represents a 12.6% annual increase since 2022 (Figure INT 4). The number of heart transplants performed in 2023 reached a record high of 4,599, a 10.5% increase over 2022 and up from 2,554 in 2013 (Figure INT 6). Among the cohort of heart transplant recipients in 2016-2018, 1-year and 5-year patient survival were 91.7% and 80.8%, respectively (Figure INT 8). Of note, a record number of DCD hearts were transplanted in 2023—representing 13.4% of all deceased donor heart transplants (Figure INT 9).

6 Trends in Lung Transplant

In 2023, there were 4,438 candidates on the lung waiting list, a 3.2% increase from 2022 (Figure INT 2). The year 2023 saw 3,427 new listings, a 6.8% increase from 2022 (Figure INT 4). The 3,080 lung transplants performed in 2023 was a record high and a 12.3% increase from 2022. This is a sign not only of continued recovery from the COVID-19 pandemic (the prepandemic number of lung transplants was 2,759 in 2019) but also of additional growth (Figure INT 6). Among the cohort of lung transplant recipients in 2016-2018, 1-year and 5-year survival were 89.0% and 60.1%, respectively. This represents the lowest 5-year patient survival among all solid organ transplants. Of note, a record number of DCD lungs were transplanted in 2023—representing 10.1% of all deceased donor lung transplants (Figure INT 9).

7 Summary

In 2023, the transplant community has continued to increase the use of DCD organs among kidney, liver, heart, and lung recipients, at record levels. As in the previous year, the transplant community set another record for the number of solid organ transplants performed in the country. Over the past decade (2013-2023), the number of kidney transplants increased by 59%; liver transplants, by 65%; heart transplants, by 80%; and lung transplants, by 58%. During the same period, there was a decline of 10% for pancreas transplant and of 13% for intestine transplants. Since 2013, the number of candidates on the waiting list increased for kidney, kidney-pancreas, heart, and lung transplants and decreased for liver, intestine, and pancreas-alone transplants. The last decade also saw an increase in the number of newly listed candidates for kidney, kidney-pancreas, liver, heart, and lung transplant and a decline in the number of newly listed candidates for intestine and pancreas-alone transplant. The growth in transplants overall was outpaced by the waitlist additions, thereby highlighting the continued supply-demand imbalance in solid organ transplantation. Since 2013, the growth in the number of organs recovered for the purpose of transplant but ultimately not transplanted for kidney, liver, heart, and lung—with intestine stabilizing and pancreas declining—represent an opportunity for improving efficiency in the system. Each organ-specific chapter and the chapter on deceased organ donation in this Annual Data Report present a more detailed look at the status of organ donation and transplantation in the United States.

Support, Copyright, and Citation Information

This publication was produced for the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), by Hennepin Healthcare Research Institute (HHRI) and the United Network for Organ Sharing (UNOS) under contracts HHSH75R60220C00011 and HHSH250201900001C, respectively. Dr. Israni was supported in part by AHRQ R01HS028829.

This publication lists nonfederal resources in order to provide additional information to consumers. The views and content in these resources have not been formally approved by HHS or HRSA. Neither HHS nor HRSA endorses the products or services of the listed resources.

The OPTN/SRTR 2023 Annual Data Report is not copyrighted. Readers are free to duplicate and use all or part of the information contained in this publication. Data are not copyrighted and may be used without permission if appropriate citation information is provided.

Pursuant to 42 U.S.C. 1320b-10, this publication may not be reproduced, reprinted, or redistributed for a fee without specific written authorization from HHS.

Suggested Citations:

Full citation: Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR). OPTN/SRTR 2023 Annual Data Report. U.S. Department of Health and Human Services, Health Resources and Services Administration; 2025. Accessed [insert date]. https://srtr.transplant.hrsa.gov/annualdatareports
Abbreviated full citation: OPTN/SRTR 2023 Annual Data Report. HHS/HRSA; 2025. Accessed [insert date]. https://srtr.transplant.hrsa.gov/annualdatareports
Chapter citation: [Authors]. OPTN/SRTR 2023 Annual Data Report: [chapter]. Accessed [insert date]. https://srtr.transplant.hrsa.gov/annualdatareports
Chapter citation for AJT e-supplement available at amjtransplant.org: [Authors]. OPTN/SRTR 2023 Annual Data Report: [chapter]. Am J Transplant. 2025;25([issue and suppl numbers]):[page range]. [doi]

Publications based on data in this report or supplied on request must include a citation and the following statement: The data and analyses reported in the OPTN/SRTR 2023 Annual Data Report have been supplied by the United Network for Organ Sharing and Hennepin Healthcare Research Institute under contract with HHS/HRSA. The authors alone are responsible for reporting and interpreting these data; the views expressed herein are those of the authors and not necessarily those of the U.S. government.

This report is available at https://srtr.transplant.hrsa.gov/annualdatareports. Individual chapters may be downloaded.

List of Figures

Figure INT 1: All candidates on the kidney or liver waiting list
Figure INT 2: All candidates on the waiting list for organs other than isolated kidney or liver
Figure INT 3: New candidates added to the kidney or liver waiting list during the year
Figure INT 4: New candidates added to the waiting list during the year for organs other than isolated kidney or liver
Figure INT 5: Total counts of kidney or liver transplants
Figure INT 6: Total counts of transplants for organs other than isolated kidney or liver
Figure INT 7: Rates of organs recovered for transplant and not transplanted
Figure INT 8: Patient survival among all transplant recipients, 2016-2018, by organ
Figure INT 9: Percent of DCD transplants by organ

**All candidates on the kidney or liver waiting list.** Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the year.

Figure INT 1: All candidates on the kidney or liver waiting list. Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the year.

**All candidates on the waiting list for organs other than isolated kidney or liver.** Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the year. PAK, pancreas after kidney; PTA, pancreas transplant alone.

Figure INT 2: All candidates on the waiting list for organs other than isolated kidney or liver. Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the year. PAK, pancreas after kidney; PTA, pancreas transplant alone.

**New candidates added to the kidney or liver waiting list during the year.** A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Active and inactive patients are included.

Figure INT 3: New candidates added to the kidney or liver waiting list during the year. A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Active and inactive patients are included.

**New candidates added to the waiting list during the year for organs other than isolated kidney or liver.** A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Active and inactive patients are included. PAK, pancreas after kidney; PTA, pancreas transplant alone.

Figure INT 4: New candidates added to the waiting list during the year for organs other than isolated kidney or liver. A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Active and inactive patients are included. PAK, pancreas after kidney; PTA, pancreas transplant alone.

**Total counts of kidney or liver transplants.** Kidney: patients undergoing kidney or simultaneous pancreas-kidney transplant. Retransplants and multiorgan transplants are included.

Figure INT 5: Total counts of kidney or liver transplants. Kidney: patients undergoing kidney or simultaneous pancreas-kidney transplant. Retransplants and multiorgan transplants are included.

**Total counts of transplants for organs other than isolated kidney or liver.** Pancreas: patients undergoing pancreas or simultaneous pancreas-kidney transplant. Heart: patients undergoing heart or heart-lung transplant. Lung: patients undergoing lung or heart-lung transplant. Retransplants and multiorgan transplants are included.

Figure INT 6: Total counts of transplants for organs other than isolated kidney or liver. Pancreas: patients undergoing pancreas or simultaneous pancreas-kidney transplant. Heart: patients undergoing heart or heart-lung transplant. Lung: patients undergoing lung or heart-lung transplant. Retransplants and multiorgan transplants are included.

**Rates of organs recovered for transplant and not transplanted.** Percentage of organs not transplanted out of all organs recovered for transplant. Kidneys and lungs recovered en bloc are counted once, and those recovered separately are counted twice.

Figure INT 7: Rates of organs recovered for transplant and not transplanted. Percentage of organs not transplanted out of all organs recovered for transplant. Kidneys and lungs recovered en bloc are counted once, and those recovered separately are counted twice.

**Patient survival among all transplant recipients, 2016-2018, by organ.** Patient survival estimated using unadjusted Kaplan-Meier methods. Similar overall survival rates for kidney and pancreas recipients and liver and heart recipients may obscure an organ's line on the graph.

Figure INT 8: Patient survival among all transplant recipients, 2016-2018, by organ. Patient survival estimated using unadjusted Kaplan-Meier methods. Similar overall survival rates for kidney and pancreas recipients and liver and heart recipients may obscure an organ’s line on the graph.

**Percent of DCD transplants by organ.** All transplant recipients, including retransplant and multiorgan recipients. DCD, donation after circulatory death.

Figure INT 9: Percent of DCD transplants by organ. All transplant recipients, including retransplant and multiorgan recipients. DCD, donation after circulatory death.