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DOD

OPTN/SRTR 2017 Annual Data Report: Deceased Organ Donation

Abstract

SRTR uses data collected by OPTN to calculate metrics such as donation rate, organ yield, and rate of organs recovered for transplant but not transplanted. In 2017, 1,085,646 death and imminent death referrals were made to organ procurement organizations, of which 22,265 met the definition of eligible (11,673) or imminent neurological (10,592) deaths per OPTN policy. There were 10,286 deceased donors, and this number has been increasing since 2010. The number of organs authorized for recovery has also continued to increase since 2010. The recent increase may be in part due to the rising number of deaths of young individuals due to the opioid epidemic. In 2017, 4813 organs were discarded, including 3542 kidneys, 309 pancreata, 742 livers, 4 intestines, 33 hearts, and 272 lungs. These numbers suggest a need to reduce the number of organs discarded.

Introduction

This chapter reports data collected by the Organ Procurement and Transplantation Network (OPTN) to describe metrics such as donation rate, organ yield, and rate of organs recovered for transplant but not transplanted.

Definitions of Terms Related to Deceased Organ Donation

  • Referrals: All deaths and imminent deaths that were reported to the organ procurement organization (OPO).
  • Eligible death: As per OPTN policy 1.2 in place prior to 2017, death of a person aged 70 years or younger who is legally declared brain dead according to hospital policy and does not exhibit any of the following indications: tuberculosis, human immunodeficiency virus (HIV) infection with specified conditions, Creutzfeldt-Jacob Disease, herpetic septicemia, rabies, reactive hepatitis B surface antigen, any retrovirus infection, active malignant neoplasms (except primary central nervous system tumors and skin cancers), Hodgkin disease, multiple myeloma, leukemia, miscellaneous carcinomas, aplastic anemia, agranulocytosis, fungal and viral encephalitis, gangrene of bowel, extreme immaturity, or positive serological or viral culture findings for HIV. On January 1, 2017, a new eligible death definition was enacted. As per this new definition, eligible death is death of a person aged 75 years old or younger who is legally declared brain dead according to state or local law, has a body weight of 5 kg or more, has a body mass index of 50 kg/m2 or lower and has at least one kidney, liver, heart, or lung that is deemed to meet the eligible data definitions as per the new OPTN policy 1.2.
  • Donor: A person from whom at least one organ was recovered for the purpose of transplant, regardless of whether the organ was transplanted.
  • Eligible donor: A donor whose death met the definition of eligible death.
  • Organs authorized for recovery: Consent requested and given for recovery of specific organs from a donor. Recovery of organs for transplant must be specifically authorized by the individual(s) authorizing the donation, whether that is the donor or a surrogate donation decision maker, consistent with applicable state law.
  • Donation rate: Number of eligible donors per 100 eligible deaths.
  • Organs recovered per donor (ORPD): Total number of organs recovered divided by the number of donors, not limited to eligible deaths.
  • Organs transplanted per donor (OTPD): Total number of organs transplanted divided by the number of donors, not limited to eligible deaths. For example, the OTPD for kidneys is the total number of kidneys transplanted divided by the total number of all donors.
  • Organ yield metric: Ratio of observed to expected numbers of organs transplanted; expected numbers based on national experience with similar donors.
  • Discards or organs recovered for transplant but not transplanted: This is calculated by dividing the number of organs recovered for the purpose of transplant but not transplanted by the number of organs recovered for the purpose of transplant.
  • DBD: Donations after brain death
  • DCD: Donations after circulatory death

Donors

In 2017, 1,085,646 death and imminent death referrals were reported to OPTN by OPOs, an increase from 1,072,717 in 2016. These referrals included 11,673 individuals who met the definition of eligible deaths as defined by OPTN policy, an increase from 8947 in 2012. There were 22,265 imminent neurological and eligible deaths in 2017, a slight decline from 23,443 in 2016, which was anticipated due to changes in the OPTN definition of imminent neurological and eligible deaths.(Figure DOD 2) One of the changes to the definition of imminent neurological death was the change from the absence of three brain stem reflexes to the absence of spontaneous breathing and two other brain stem reflexes. There were 10,286 deceased donors, increased from 9971 in 2016, and this number has been increasing since 2010. The number of deceased donor transplants increased to 28,582 in 2017 from 27,622 in 2016 and 24,980 in 2015. This is in contrast to the decline or lack of growth in numbers of deceased donor transplants in previous years. In 2017, 6182 living donor transplants (difference between total transplants and deceased donor transplants) were performed, an increase from 5976 in 2016. This is a change from 2016, when there was a slight decreased from 5989 in 2015 (Figure DOD 2). Donations after brain death (DBD) increased to 8403 in 2017, from 8287 in 2016. Donations after circulatory death (DCD) increased to 1883 from 1684 in 2016. This represents a continuing steady increase in DBD and DCD donations since 2010 (Figure DOD 3). The number of organs authorized for recovery from deceased donors continued to increase to 73,660 in 2017, from 71,550 in 2016 and 55,348 since 2010. The number of organs recovered for transplant and transplanted increased to 29,435 from 28,454 in 2016 and 23,045 since 2012 (Figure DOD 4). Potential reasons for the growth in organs authorized for recovery, donors, and numbers of deceased donor transplants include the rising number of deaths of young individuals due to the opioid epidemic and increasing use of organs from DBD donors.

Donation Rate

OPTN policy requires that OPOs report all eligible deaths for OPO performance assessment. However, any performance metric based solely on eligible deaths uses only a subset of potential donors, since successful donations can come from donors not meeting the eligible death definition, e.g., DCD or donors aged older than 70 years. Recognizing this limitation, SRTR’s current donation rate is a measure of how often an eligible death becomes a donor. In 2017, the donation rate was 69.6 eligible donors per 100 eligible deaths, a decrease from 72.3 in 2016 and 72.2 in 2015. However, the 2017 changes in OPTN policy 1.2 defining eligible deaths make it difficult to draw firm conclusion on differences in donation rate between 2017 and prior years. Unadjusted donation rates varied by donation service area (DSA), ranging from 55.7 to 88.0 (Figure DOD 5). This range decreased slightly from 2016, when it varied from 52.9 to 93.3. Risk-adjusted donation rates are presented for each OPO biannually in the OPO reports on the SRTR website.

The donation rate varied by organ. In 2017, the highest rate was 63.1 eligible donors per 100 eligible deaths, for 7368 kidneys from 11,673 eligible deaths. This represents a slight decrease from 2016, when the donation rate was 66.7 eligible donors per 100 eligible deaths for kidneys. However, the number of kidney eligible donors increased from 7143 in 2016 due to the increase in the number of eligible deaths. In 2017, the next highest donation rate after kidneys was 63.6 for livers, from 7420 liver eligible donors. The pattern was similar for livers, with a slight decrease in the donation rate in 2017 compared with 2016, but an increase in numbers of liver donors due to increases in numbers of eligible deaths. In 2016, the donation rate was 65.6 for liver, from 7041 liver eligible donors. However, the 2017 changes in OPTN policy 1.2 defining eligible deaths make it difficult to draw firm conclusion on differences in organ specific donation rate for between 2017 and prior years.

In 2017, the lowest donation rate was 10.7 for pancreas, from 1249 pancreas eligible donors. Compared with 2016, the donation rate for pancreas donors decreased from 12.0 and the number of donors decreased from 1283 pancreas eligible donors (Figure DOD 6). In 2017, the donation rate for heart was 28.1 from 3279 heart eligible donors and the donation rate for lung was 19.8 from 2310 lung eligible donors.

Organs Recovered per Donor

In 2017, 3.54 organs were recovered per donor, the same as in 2016 and slightly higher than 3.51 in 2015 and 3.50 in 2014 (Figure DOD 7). The ORPD for all organs combined has been relatively stable compared with 2014 (Figure DOD 7, Figure DOD 8). Given that each donor can potentially donate two kidneys, the ORPD was highest for kidneys, followed by livers (Figure DOD 7, Figure DOD 8). ORPDs have remained stable for kidneys and slightly decreased for livers over the past decade. ORPDs have increased for hearts and lungs over the past decade, remained unchanged for intestine, and declined for pancreata (Figure DOD 8). In 2017, the ORPD varied substantially by DSA, ranging from 2.74 to 4.15, a slightly decreased range from 2.90 to 4.19 in 2016 (Figure DOD 9). The ORPD is an unadjusted number, and thus represents a mix of donor types, including young and old and DBD and DCD which explains some of the differences observed. The ORPD for kidneys varied across DSAs from 1.55 to 1.96; for pancreata, from 0 to 0.25; for livers, from 0.60 to 0.98; for intestines, from 0.0 to 0.04; for hearts, from 0 to 0.49; and for lungs, from 0.05 to 0.66 (Figure DOD 9).

Organs Transplanted per Donor and Organ Yield

The number of OTPD was 3.07 in 2017, slightly increased from 3.06 in 2016, and 3.03 in 2015 and 2014 (Figure DOD 10). Given that each donor can potentially donate two kidneys, the OTPD was highest for kidneys, followed by livers (Figure DOD 10, Figure DOD 11). OTPD increased for lungs over the past decade, but declined for pancreata (Figure DOD 11). The numbers of deceased donor organs transplanted in 2017 were as follows: 15,144 kidneys, 1000 pancreata, 7631 livers, 108 intestines, 3272 hearts, and 4359 lungs. In a 2017 unadjusted analysis, not accounting for the mix of DBD and DCD donor types, OTPD varied substantially by DSA, ranging from 2.31 to 3.76 (Figure DOD 12). In 2017, the OTPD for kidneys varied by DSA from 1.20 to 1.71; for pancreata, from 0 to 0.21; for livers, from 0.58 to 0.95; for intestines, from 0 to 0.04; for hearts, from 0 to 0.48; and for lungs, from 0.05 to 0.66.

The OTPD from DBD donors was 3.33 in 2017, slightly higher than 3.29 in 2016, 3.25 in 2015, and 3.22 in 2014. The OTPD from DCD donors was 1.92 in 2017, slightly lower than 1.93 in 2015 and 2016, and 1.97 in 2014 (Figure DOD 13). In 2017, of the 10,286 donors, 18.3% nationally were DCD, an increase from 17% in 2016, 16% in 2015 and 15% in 2014.

In 2017, average numbers of kidneys transplanted per donor were 1.46 for DBD (12,236 kidneys, higher than 11,890 in 2016 and 10,919 in 2015) and 1.54 for DCD (2908 kidneys more than 2611 in 2016 and 2332 in 2015) donors (Figure DOD 14). Although the number of kidneys transplanted per donor for DBD donors decreased compared with 2016, the number of kidneys increased due to the increase in the number of donors. The average number of kidneys transplanted varied by kidney donor profile index (KDPI), and was 1.93, 1.87, 1.55, 0.63 for KDPI <0.20, 0.21-0.34, 0.35-0.85, and >0.85, respectively (Figure DOD 20). The number of kidneys transplanted increased slightly for each category of KDPI. Apart from kidney donors, OTPD was higher from DBD than from DCD donors (Figure DOD 14, Figure DOD 15, Figure DOD 16, Figure DOD 17, Figure DOD 18, Figure DOD 19). The OTPD for kidneys has been higher from DCD than from DBD donors since 2006 (Figure DOD 14). The number of DCD liver donors continued to increase, from 450 in 2016 to 517 in 2017, but the number of DBD liver donors increased more, from 6961 in 2016 to 7114 in 2017. Similarly, the number of DCD lungs continued to increase, from 163 in 2016 to 165 in 2017, but the number of DCD lung donors increased more, from 3956 in 2016 to 4194 in 2017. Among DBD organs, only the number of DBD pancreata and DBD intestines continued to decline. The number of DBD pancreata declined from 992 in 2016 to 974 in 2017,and intestines declined from 147 in 2016 to 108 in 2017.

The yield metric shown in Figure DOD 21, Figure DOD 22, Figure DOD 23, Figure DOD 24, Figure DOD 25, and Figure DOD 26 compares the number of organs transplanted (observed) in 2016-2017 with the number of organs that would be expected to be transplanted based on the national experience with similar donors (expected). A ratio, expressed as observed/expected organs transplanted, of less than 1 indicates that fewer organs were transplanted than would be expected based on the national models for that organ. A ratio of more than 1 indicates that more organs were transplanted than would be expected. The mean observed/expected ratio for all organs varied from 0.93 to 1.10.

Organs Recovered for Transplant but Not Transplanted

The number of organs recovered for transplant but not transplanted is calculated by subtracting the number of organs transplanted from the number of organs recovered for the purpose of transplant. The percentage of organs not transplanted is then calculated by dividing the number of organs not transplanted by the number of organs recovered for the purpose of transplant. The percentage in 2017 for all organs combined was 13.2 per recovered organ, slightly lower than 13.8 per recovered organ in 2016 (Figure DOD 27). In 2017, 4813 organs were discarded, slightly less than 4859 in 2016 and slightly more than 4368 in 2015. In 2017, 3542 kidneys, 309 pancreata, 742 livers, 4 intestines, 33 hearts, and 272 lungs were discarded. (Figure DOD 27). The numbers of kidneys, livers, and hearts discarded increased from 3631, 739, and 31, respectively, in 2016 (Figure DOD 27).

Use of DCD Organs and High KDPI Kidneys

Use of DCD organs also varied (Figure DOD 28). The percentage of DCD donor organs among deceased donor transplant recipients varied across DSAs from 0 to 37.2. The percentage of donors with KDPI higher than 0.85 also varied across the DSAs, ranging from 0 to 29.9 (Figure DOD 29).

Disposition of Organs

The disposition of actual organs is described in Figure DOD 30, Figure DOD 31, Figure DOD 32, Figure DOD 33, Figure DOD 34, Figure DOD 35, Figure DOD 36, and Figure DOD 37. Donor characteristics in 2017 are compared with characteristics in 2006 in Table DOD 1. The most remarkable difference was the increase in HIV-positive donors to 6 in 2017 from none in 2007. This increase is due to the HIV Organ Policy Equity Act (HOPE), which modified rules regarding organ donation between HIV-positive individuals and authorized use of these organs as part of clinical research. Other remarkable differences were an increase in anoxia as cause of donor death from 18.5% in 2007 to 42.2% in 2017, and a decrease in stroke from 40.9% in 2007 to 26.6% in 2017. The number of DCD donors increased from 8.2% in 2007 to 16.1% in 2017. The increase in number of donors aged 18-34 years from 26.4% to 30.8% possibly reflects increased deaths due to the opioid abuse epidemic. Another demographic change noted was a decrease in US citizenship among donors from 98.5% in 2007 to 89.5% in 2017, with a concomitant increase in non-US citizenship from 0% in 2007 to 3.2% in 2017. Likewise, other/unknown citizenship increased from 1.5% in 2007 to 7.2% in 2017.

Figure List

Summary

Figure DOD 1. Relationship between deaths, donations, and transplants
Figure DOD 2. Overall counts of eligible deaths, donors, and transplants, 2006-2017
Figure DOD 3. Overall counts of deceased donors, DBD donors, and DCD donors, 2006-2017
Figure DOD 4. Overall counts of authorized, recovered and transplanted organs, 2006-2017

Donation rates

Figure DOD 5. Eligible Donors per 100 eligible deaths by DSA, 2017
Figure DOD 6. Overall and organ-specific eligible donors per 100 eligible deaths, 2017

Organs recovered per donor

Figure DOD 7. Organs recovered per donor, all organs and kidney
Figure DOD 8. Organs recovered per donor, pancreas, liver, intestine, heart, and lung
Figure DOD 9. Organs recovered per donor by DSA, 2017

Organs transplanted per donor

Figure DOD 10. Organs transplanted per donor, all organs and kidney
Figure DOD 11. Organs transplanted per donor, pancreas, liver, intestine, heart, and lung
Figure DOD 12. Organs transplanted per donor, by DSA, 2017
Figure DOD 13. Organs transplanted per donor, by DBD and DCD status
Figure DOD 14. Kidneys transplanted per donor, by DBD and DCD status
Figure DOD 15. Pancreata transplanted per donor, by DBD and DCD status
Figure DOD 16. Livers transplanted per donor, by DBD and DCD status
Figure DOD 17. Intestines transplanted per donor, by DBD and DCD status
Figure DOD 18. Hearts transplanted per donor, by DBD and DCD status
Figure DOD 19. Lungs transplanted per donor, by DBD and DCD status
Figure DOD 20. Kidneys transplanted per donor, by KDPI

Yield

Figure DOD 21. Observed-to-expected yield per kidney, 2016-2017
Figure DOD 22. Observed-to-expected yield per pancreas, 2016-2017
Figure DOD 23. Observed-to-expected yield per liver, 2016-2017
Figure DOD 24. Observed-to-expected yield per intestine, 2016-2017
Figure DOD 25. Observed-to-expected yield per heart, 2016-2017
Figure DOD 26. Observed-to-expected yield per lung, 2016-2017

Organ recovered for transplant and not transplanted

Figure DOD 27. Organs recovered for transplant and not transplanted

Organ quality

Figure DOD 28. Variation in percentage of DCD donors from all donors
Figure DOD 29. Variation in percentage of kidney donors with KDPI greater than 85% among deceased donor kidney transplant recipients, by DSA, 2017

Organ use charts

Figure DOD 30. Organ use chart for reported left kidneys, 2017
Figure DOD 31. Organ use chart for reported right kidneys, 2017
Figure DOD 32. Organ use chart for reported en bloc kidneys, 2017
Figure DOD 33. Organ use chart for pancreas, 2017
Figure DOD 34. Organ use chart for liver, 2017
Figure DOD 35. Organ use chart for intestine, 2017
Figure DOD 36. Organ use chart for heart, 2017
Figure DOD 37. Organ use chart for lung, 2017

Table List

Donor characteristics

Table DOD 1. Characteristics of deceased donors, 2007 and 2017

A venn diagram that illustrates the difficult conceptual definitions and relationships between donor deaths and becoming an organ donor. Basically, the true potential donor pool is only contained by in-hospital deaths but overlaps and is not contained by referrals to OPO, eligible deaths.

Figure DOD 1. Relationship between deaths, donations, and transplants
Conceptual schematic (Venn diagram) of actual and potential organ donors. A. Only in rare instances do out-of-hospital deaths result in organ donation. B. Most in-hospital deaths are reported to the local organ procurement organization. C. The number of "True" Potential Donors (dashed circle) is yet to be defined. D. Eligible Deaths. E. Actual donors, not all of whom result in transplants. F. Deceased donor transplants. OPO, organ procurement organization.


A line plot for overall counts of eligible deaths, donors, and transplants, 2006-2017; the imminent or eligible deaths category is NA count at 2006 and is count at 2017; the eligible deaths category is NA count at 2006 and is count at 2017; the deceased donors (dd) category increases by 28.3% from 8017 count at 2006 to 10286 count at 2017; the dd meeting eligibility criteria category is NA count at 2006 and is count at 2017; the total transplants category increases by 20.1% from 28941 count at 2006 to 34764 count at 2017; and the dd transplants category increases by 28.7% from 22207 count at 2006 to 28582 count at 2017.

Figure DOD 2. Overall counts of eligible deaths, donors, and transplants, 2006-2017
The number and source of donors with the number of transplants.


A line plot for overall counts of deceased donors, dbd donors, and dcd donors, 2006-2017; the deceased donors category increases by 28.3% from 8017 count at 2006 to 10286 count at 2017; the dbd donors category increases by 13.9% from 7375 count at 2006 to 8403 count at 2017; and the dcd donors category increases by 193.3% from 642 count at 2006 to 1883 count at 2017.

Figure DOD 3. Overall counts of deceased donors, DBD donors, and DCD donors, 2006-2017
The number of deceased donors, dbd donors and dcd donors


A line plot for overall counts of authorized, recovered and transplanted organs, 2006-2017; the organs authorized category increases by 34.2% from 54890 count of organs at 2006 to 73660 count of organs at 2017; the organs recovered category increases by 29.7% from 29476 count of organs at 2006 to 38229 count of organs at 2017; and the organs transplanted category increases by 26.7% from 23225 count of organs at 2006 to 29435 count of organs at 2017.

Figure DOD 4. Overall counts of authorized, recovered and transplanted organs, 2006-2017
The number of authorized , recovered, and transplanted organs.


A map of eligible donors per 100 eligible deaths by dsa, 2017, the values range from 55.77 to 88.02.

Figure DOD 5. Eligible Donors per 100 eligible deaths by DSA, 2017
Donation rate is the number of deceased donors meeting eligibility criteria per 100 eligible deaths. An eligible death is any hospital-reported death that is evaluated and meets organ donor eligibility requirements, with none of the exclusions listed in OPTN policy.


A bar plot for overall and organ-specific eligible donors per 100 eligible deaths, 2017, the all group is 69.61 eligible donors per 100 eligible deaths; the kidney group is 63.12 eligible donors per 100 eligible deaths; the pancreas group is 10.70 eligible donors per 100 eligible deaths; the liver group is 63.57 eligible donors per 100 eligible deaths; the heart group is 28.09 eligible donors per 100 eligible deaths; and the lung group is 19.79 eligible donors per 100 eligible deaths.

Figure DOD 6. Overall and organ-specific eligible donors per 100 eligible deaths, 2017
Organ-specific rates represent the number of donors of each organ type meeting eligibility criteria per 100 eligible deaths.


A line plot for organs recovered per donor, all organs and kidney; the all category is 3.5 organs per donor at 2006 and remains relatively constant with a value of 3.5 organs per donor at 2017; and the kidneys category is 1.8 organs per donor at 2006 and remains relatively constant with a value of 1.8 organs per donor at 2017.

Figure DOD 7. Organs recovered per donor, all organs and kidney
Average number of overall organs and kidneys recovered per donor, calculated as the sum of recovered organs and by organ type; i.e., up to two kidneys can be recovered from each donor, but only one heart. Pancreata recovered for islet transplant are excluded.


A line plot for organs recovered per donor, pancreas, liver, intestine, heart, and lung; the pancreas category decreases by 47.0% from 0.2 organs per donor at 2006 to 0.1 organs per donor at 2017; the liver category is 0.9 organs per donor at 2006 and remains relatively constant with a value of 0.8 organs per donor at 2017; the intestine category decreases by 52.6% from 0 organs per donor at 2006 to 0 organs per donor at 2017; the heart category increases by 13.2% from 0.3 organs per donor at 2006 to 0.3 organs per donor at 2017; and the lung category increases by 46.7% from 0.3 organs per donor at 2006 to 0.5 organs per donor at 2017.

Figure DOD 8. Organs recovered per donor, pancreas, liver, intestine, heart, and lung
Average number of organs other than kidneys recovered per donor, calculated as the sum of recovered organs and by organ type. Pancreata recovered for islet transplant are excluded.


A map of organs recovered per donor by dsa, 2017, the values range from 2.74 to 4.15.

Figure DOD 9. Organs recovered per donor by DSA, 2017
Average number of organs recovered per donor, calculated as the sum of recovered organs and by organ type; i.e., up to two kidneys can be recovered from each donor, but only one heart. Pancreata recovered for islet transplant are excluded.


A line plot for organs transplanted per donor, all organs and kidney; the all category is 3.1 organs per donor at 2006 and remains relatively constant with a value of 3.1 organs per donor at 2017; and the kidneys category is 1.5 organs per donor at 2006 and remains relatively constant with a value of 1.5 organs per donor at 2017.

Figure DOD 10. Organs transplanted per donor, all organs and kidney
Average number of overall organs and kidneys transplanted per donor. As organs divided into segments (liver, lung, pancreas, intestine) may account for more than one transplant, the number or organs transplanted may exceed the number recovered. Based on a count of recovered organs that are transplanted, which differs from number of transplant operations. Pancreata recovered for islet transplant are excluded.


A line plot for organs transplanted per donor, pancreas, liver, intestine, heart, and lung; the pancreas category decreases by 43.9% from 0.2 organs per donor at 2006 to 0.1 organs per donor at 2017; the liver category is 0.8 organs per donor at 2006 and remains relatively constant with a value of 0.7 organs per donor at 2017; the intestine category decreases by 50.8% from 0 organs per donor at 2006 to 0 organs per donor at 2017; the heart category increases by 13.4% from 0.3 organs per donor at 2006 to 0.3 organs per donor at 2017; and the lung category increases by 42.7% from 0.3 organs per donor at 2006 to 0.4 organs per donor at 2017.

Figure DOD 11. Organs transplanted per donor, pancreas, liver, intestine, heart, and lung
Average number of organs other than kidneys transplanted per donor. As organs divided into segments (liver, lung, pancreas, intestine) may account for more than one transplant, the number or organs transplanted may exceed the number recovered. Based on a count of recovered organs that are transplanted, which differs from number of transplant operations. Pancreata recovered for islet transplant are excluded.


A map of organs transplanted per donor, by dsa, 2017, the values range from 2.31 to 3.76.

Figure DOD 12. Organs transplanted per donor, by DSA, 2017
Average number of organs transplanted per donor. As organs divided into segments (liver, lung, pancreas, intestine) may account for more than one transplant, the number or organs transplanted may exceed the number recovered. Based on a count of recovered organs that are transplanted, which differs from number of transplant operations. DSA-level means are shown. Pancreata recovered for islet transplant are excluded.


A line plot for organs transplanted per donor, by dbd and dcd status; the dbd category is 3.1 organs per donor at 2006 and remains relatively constant with a value of 3.3 organs per donor at 2017; and the dcd category is 2.1 organs per donor at 2006 and remains relatively constant with a value of 1.9 organs per donor at 2017.

Figure DOD 13. Organs transplanted per donor, by DBD and DCD status
Average number of organs transplanted per donor. As organs divided into segments (liver, lung, pancreas, intestine) may account for more than one transplant, the number of organs transplanted may exceed the number recovered. Based on a count of recovered organs that are transplanted, which differs from number of transplant operations. DSA-level means are shown. Pancreata recovered for islet transplant are excluded.


A line plot for kidneys transplanted per donor, by dbd and dcd status; the dbd category is 1.5 kidneys per donor at 2006 and remains relatively constant with a value of 1.5 kidneys per donor at 2017; and the dcd category is 1.6 kidneys per donor at 2006 and remains relatively constant with a value of 1.5 kidneys per donor at 2017.

Figure DOD 14. Kidneys transplanted per donor, by DBD and DCD status
Average number of kidneys transplanted per donor. Based on a count of recovered kidneys that are transplanted, which differs from number of transplant operations. DSA-level means are shown.


A line plot for pancreata transplanted per donor, by dbd and dcd status; the dbd category decreases by 37.0% from 0.2 pancreata per donor at 2006 to 0.1 pancreata per donor at 2017; and the dcd category decreases by 73.9% from 0.1 pancreata per donor at 2006 to 0 pancreata per donor at 2017.

Figure DOD 15. Pancreata transplanted per donor, by DBD and DCD status
Average number of pancreata transplanted per donor. Pancreata divided into segments may account for more than one transplant, the number of pancreata transplanted may exceed the number recovered. Based on a count of recovered pancreata that are transplanted, which differs from number of transplant operations. DSA-level means are shown. Pancreata recovered for islet transplant are excluded.


A line plot for livers transplanted per donor, by dbd and dcd status; the dbd category is 0.8 livers per donor at 2006 and remains relatively constant with a value of 0.8 livers per donor at 2017; and the dcd category decreases by 39.0% from 0.5 livers per donor at 2006 to 0.3 livers per donor at 2017.

Figure DOD 16. Livers transplanted per donor, by DBD and DCD status
Average number of livers transplanted per donor. Livers divided into segments may account for more than one transplant, the number of livers transplanted may exceed the number recovered. Based on a count of recovered livers that are transplanted, which differs from number of transplant operations. DSA-level means are shown.


A line plot for intestines transplanted per donor, by dbd and dcd status; the dbd category decreases by 44.6% from 0 intestines per donor at 2006 to 0 intestines per donor at 2017; and the dcd category is 0 intestines per donor at 2006 and is intestines per donor at 2017.

Figure DOD 17. Intestines transplanted per donor, by DBD and DCD status
Average number of intestines transplanted per donor. Intestines divided into segments may account for more than one transplant, the number of intestines transplanted may exceed the number recovered. Based on a count of recovered intestines that are transplanted, which differs from number of transplant operations. DSA-level means are shown.


A line plot for hearts transplanted per donor, by dbd and dcd status; the dbd category increases by 27.7% from 0.3 hearts per donor at 2006 to 0.4 hearts per donor at 2017; and the dcd category is 0 hearts per donor at 2006 and is hearts per donor at 2017.

Figure DOD 18. Hearts transplanted per donor, by DBD and DCD status
Average number of hearts transplanted per donor. Based on a count of recovered hearts that are transplanted, which differs from number of transplant operations. DSA-level means are shown.


A line plot for lungs transplanted per donor, by dbd and dcd status; the dbd category increases by 56.2% from 0.3 lungs per donor at 2006 to 0.5 lungs per donor at 2017; and the dcd category increases by 134.4% from 0 lungs per donor at 2006 to 0.1 lungs per donor at 2017.

Figure DOD 19. Lungs transplanted per donor, by DBD and DCD status
Average number of lungs transplanted per donor. Lungs divided into segments may account for more than one transplant, the number of lungs transplanted may exceed the number recovered. Based on a count of recovered lungs that are transplanted, which differs from number of transplant operations. DSA-level means are shown.


A line plot for kidneys transplanted per donor, by kdpi; the kdpi less than or equal to 0.20 category is 1.9 kidneys per donor at 2006 and remains relatively constant with a value of 1.9 kidneys per donor at 2017; the kdpi 0.21 to 0.34 category is 1.9 kidneys per donor at 2006 and remains relatively constant with a value of 1.9 kidneys per donor at 2017; the kdpi 0.35 to 0.85 category is 1.6 kidneys per donor at 2006 and remains relatively constant with a value of 1.6 kidneys per donor at 2017; and the kdpi greater than 0.85 category decreases by 17.8% from 0.8 kidneys per donor at 2006 to 0.6 kidneys per donor at 2017.

Figure DOD 20. Kidneys transplanted per donor, by KDPI
Average number of kidneys transplanted per donor. Based on a count of recovered kidneys that are transplanted, which differs from number of transplant operations. KDPI, kidney donor profile index.


A map of observed-to-expected yield per kidney, 2016-2017, the values range from 0.92 to 1.11.

Figure DOD 21. Observed-to-expected yield per kidney, 2016-2017
Donor yield is a measure of organs transplanted per donor. Expected yield is estimated from statistical models that take into account various charasteristics not under the control of OPOs. Kidney transplants are counted separately as zero, one, or two.


A map of observed-to-expected yield per pancreas, 2016-2017, the values range from 0.18 to 2.18.

Figure DOD 22. Observed-to-expected yield per pancreas, 2016-2017
Donor yield is a measure of organs transplanted per donor. Expected yield is estimated from statistical models that take into account various charasteristics not under the control of OPOs.


A map of observed-to-expected yield per liver, 2016-2017, the values range from 0.81 to 1.13.

Figure DOD 23. Observed-to-expected yield per liver, 2016-2017
Donor yield is a measure of organs transplanted per donor. Expected yield is estimated from statistical models that take into account various charasteristics not under the control of OPOs.


A map of observed-to-expected yield per intestine, 2016-2017, the values range from 0.00 to 5.00.

Figure DOD 24. Observed-to-expected yield per intestine, 2016-2017
Donor yield is a measure of organs transplanted per donor. Expected yield is estimated from statistical models that take into account various charasteristics not under the control of OPOs.


A map of observed-to-expected yield per heart, 2016-2017, the values range from 0.82 to 1.26.

Figure DOD 25. Observed-to-expected yield per heart, 2016-2017
Donor yield is a measure of organs transplanted per donor. Expected yield is estimated from statistical models that take into account various charasteristics not under the control of OPOs.


A map of observed-to-expected yield per lung, 2016-2017, the values range from 0.32 to 1.85.

Figure DOD 26. Observed-to-expected yield per lung, 2016-2017
Donor yield is a measure of organs transplanted per donor. Expected yield is estimated from statistical models that take into account various charasteristics not under the control of OPOs. Single-lung and double-lung transplants are both counted as one organ transplant.


A line plot for organs recovered for transplant and not transplanted; the overall category is 13.1 percent at 2006 and remains relatively constant with a value of 13.2 percent at 2017; the kidney category increases by 14.3% from 16.6 percent at 2006 to 19 percent at 2017; the pancreas category decreases by 15.2% from 27.8 percent at 2006 to 23.6 percent at 2017; the liver category decreases by 11.8% from 10.1 percent at 2006 to 8.9 percent at 2017; the intestine category decreases by 49.5% from 7.1 percent at 2006 to 3.6 percent at 2017; the heart category decreases by 15.8% from 1.2 percent at 2006 to 1 percent at 2017; and the lung category increases by 80.7% from 3.3 percent at 2006 to 5.9 percent at 2017.

Figure DOD 27. Organs recovered for transplant and not transplanted
Percents are calculated as the difference between the number of organs recovered and the number of organs transplanted, divided by the number of organs recovered. Pancreata recovered for islet transplant are excluded.


A map of variation in percentage of dcd donors from all donors, the values range from 0.00 to 37.16.

Figure DOD 28. Variation in percentage of DCD donors from all donors
Percentage of dcd donors within an DSA


A map of variation in percentage of kidney donors with kdpi greater than 85% among deceased donor kidney transplant recipients, by dsa, 2017, the values range from 0.00 to 29.90.

Figure DOD 29. Variation in percentage of kidney donors with KDPI greater than 85% among deceased donor kidney transplant recipients, by DSA, 2017
Percentage of deceased donor transplants within a DSA with KDPI greater than, or equal to, 85%.


A chart that summarizes the donor disposition, or organ use, of donated left kidneys. The most common disposition is transplante

Figure DOD 30. Organ use chart for reported left kidneys, 2017
A summary of the consent, recovered, tranplanted or discarded status for donated left kidneys. The number of left and right kidneys may not equal the total number of donors.


A chart that summarizes the donor disposition, or organ use, of donated right kidneys. The most common disposition is Transplanted (6,287, 73.0%) followed by recovered for transplant but not transplanted (1,556, 18.1%). 660 (7.7%) of right kidneys were not recovered.

Figure DOD 31. Organ use chart for reported right kidneys, 2017
A summary of the consent, recovered, tranplanted or discarded status for donated right kidneys. The number of left and right kidneys may not equal the total number of donors.


A chart that summarizes the donor disposition, or organ use, of donated en bloc kidneys. The most common disposition is transplanted (285, 61.7%) followed by recovered for transplant but not transplanted (78, 16.9%). 63 (13.6%) of right kidneys were not recovered.

Figure DOD 32. Organ use chart for reported en bloc kidneys, 2017
A summary of the consent, recovered, tranplanted or discarded status for donated en bloc kidneys. The number of en bloc kidneys may not equal the total number of donors.


A chart that summarizes the donor disposition, or organ use, of donated pancreas. The most common disposition is not recovered (6,872, 75.7%) followed by transplanted (950, 10.5%). 320 (3.5%) of pancreas were recovered for transplant but not transplanted.

Figure DOD 33. Organ use chart for pancreas, 2017
A summary of the consent, recovered, tranplanted or discarded status for donated pancreas.


A chart that summarizes the donor disposition, or organ use, of donated livers. The most common disposition is transplanted (6,714, 73.9%) followed by not recovered (1,224, 13.5%). 703 (7.7%) of livers were recovered for transplant but not transplanted.

Figure DOD 34. Organ use chart for liver, 2017
A summary of the consent, recovered, tranplanted or discarded status for donated livers.


A chart that summarizes the donor disposition, or organ use, of donated intestines. The most common disposition is not recovered (8,127, 89.5%) followed by consent not obtained (338, 3.7%). 139 (1.5%) of intestines were transplanted and 17 (0.2%) were recovered for transplant but not transplanted.

Figure DOD 35. Organ use chart for intestine, 2017
A summary of the consent, recovered, tranplanted or discarded status for donated intestines.


A chart that summarizes the donor disposition, or organ use, of donated hearts. The most common disposition is not recovered (4,664, 51.4%) followed by transplanted (2,824, 31.1%). 30 (0.3%) of hearts were recovered for transplant but not transplanted.

Figure DOD 36. Organ use chart for heart, 2017
A summary of the consent, recovered, tranplanted or discarded status for donated hearts.


A chart that summarizes the donor disposition, or organ use, of donated lungs. The most common disposition is not recovered (5,452, 60.0%) followed by transplanted (1,933, 21.3%). 85 (0.9%) of lungs are recovered for transplant but not transplanted.

Figure DOD 37. Organ use chart for lung, 2017
A summary of the consent, recovered, tranplanted or discarded status for donated lungs.


Table DOD 1 Characteristics of deceased donors, 2007 and 2017
The donor characteristics of age, sex, race/ethnicity, and DCD status.
Characteristic 2007, N 2007, Percent 2017, N 2017, Percent
KDPI: <20% 1554 19.2% 1816 17.7%
KDPI: 21-34% 895 11.1% 1284 12.5%
KDPI: 35-85% 3548 43.9% 4826 46.9%
KDPI: >85% 1730 21.4% 1795 17.5%
KDPI: Unknown/missing 359 4.4% 565 5.5%
HIV: Not Positive 10,280 99.9%
HIV: Positive 6 0.1%
HCV: Not Positive 7734 95.6% 9783 95.1%
HCV: Positive 352 4.4% 503 4.9%
Citizenship: US 7970 98.6% 9215 89.6%
Citizenship: Non-US 0 0.0% 332 3.2%
Citizenship: Other/unkown 116 1.4% 739 7.2%
COD: Anoxia 1490 18.4% 4336 42.2%
COD: Stroke 3308 40.9% 2736 26.6%
COD: Head Trauma 3026 37.4% 2926 28.4%
COD: CNS Tumor 46 0.6% 36 0.3%
COD: Other/unkown 216 2.7% 252 2.4%
Sex: Female 3209 39.7% 4087 39.7%
Sex: Male 4877 60.3% 6199 60.3%
Age: <18 years 926 11.5% 896 8.7%
Age: 18-34 years 2133 26.4% 3172 30.8%
Age: 35-49 years 2119 26.2% 2732 26.6%
Age: 50-64 years 2138 26.4% 2820 27.4%
Age: ≥65 years 770 9.5% 666 6.5%
Ethnicity: Non-Latino/unkown 6934 85.8% 8768 85.2%
Ethnicity: Latino 1152 14.2% 1518 14.8%
Race: White 6562 81.2% 8222 79.9%
Race: Black 1260 15.6% 1680 16.3%
Race: Asian 180 2.2% 259 2.5%
Race: Other/unkown 84 1.0% 125 1.2%
DCD status: DBD 7295 90.2% 8403 81.7%
DCD status: DCD 791 9.8% 1883 18.3%