OPTN/SRTR 2022 Annual Data Report: Introduction

David P. Schladt¹, Ajay K. Israni^1,2,3

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

²Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN

³Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN

Abstract

The OPTN/SRTR 2022 Annual Data Report presents the status of the solid organ transplant system in the United States from 2011 through 2022. 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. In addition to the organ-specific chapters, the reader will find chapters dedicated to deceased organ donation, vascularized composite allografts, and the COVID-19 pandemic. 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 waitlist and transplant activity from 2012 through 2022. More detailed descriptions can be found in the respective organ-specific chapters.

Keywords: Allocation, outcomes, transplant, waiting list

1 Trends in Kidney Transplant

In 2022, there were 142,962 adult and pediatric candidates on the kidney waiting list at some point (Figure INT 1), an increase of 0.8% from 2021. This includes active and inactive candidates on the list at any time during the year. Over the past decade (2012-2022), 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 increased to 45,286 in 2022 (Figure INT 3), an increase of 5.7% from 2021 and the highest number of new kidney candidates added since 2012. This is likely a sign of recovery from the COVID-19 pandemic, which temporarily reduced the number of additions to the waiting list in 2020. The number of kidney transplants performed also increased in 2022 to 26,309, a 3.2% increase from 2021 (Figure INT 5) and the highest number of kidney transplants of the past decade. However, there is potential for an even higher number of kidney transplants being done, based on the increasing proportion of kidneys from deceased donors recovered for the purpose of transplant but ultimately not transplanted. In 2022, the proportion of kidneys from deceased donors recovered for the purpose of transplant but not transplanted increased to 26.6%, which is an increase of 8.4% from 2021 (Figure INT 7). These kidneys when recovered en bloc were counted once, whereas kidneys recovered separately were counted twice. With more than a quarter of all kidneys procured for the purpose of transplant not transplanted, this represents an opportunity to improve efficiency in the transplant system. Among transplant recipients from 2015 through 2017, 1-year and 5-year patient survival were 97.3% and 87.5%, respectively (Figure INT 8).

2 Trends in Pancreas Transplant

The demand for pancreas transplant alone has continued to decrease, as evidenced by a decline in the number of candidates listed for pancreas-alone or pancreas-after-kidney transplant over the past decade. The number of those candidates has declined from 1,661 in 2012 to 975 in 2022, which is likely due to improvement in medical management of diabetes (Figure INT 2). In comparison, the number of candidates waiting for a simultaneous pancreas-kidney transplant has declined to a lesser degree, from 3,611 in 2012 to 3,345 in 2022. Nonetheless, that 3,345 value represents a slight (4.2%) increase from 2021. Similar trends were seen in the number of new additions to the pancreas waiting list in 2022, with declines to 283 for pancreas-alone or pancreas-after-kidney and a slight increase to 1,489 kidney-pancreas additions to the waiting list, compared with 2021 (Figure INT 4). The total number of pancreas transplants performed in the United States was 918 in 2022, a 4.6% decline from 2021 (Figure INT 6). The proportion of pancreata from deceased donors recovered for the purpose of transplant but ultimately not transplanted increased to 28.6%, a 9.1% increase from 2021. This increase is likely due to organ procurement organizations being incentivized to obtain pancreata for research under the new Centers for Medicare & Medicaid Services (CMS) performance metrics for organ procurement organizations. Among all organs, pancreas has the highest proportion of organs recovered for the purpose of transplant but not transplanted (Figure INT 7). Among transplant recipients from 2015 through 2017, 1-year and 5-year patient survival were 96.3% and 88.7%, respectively (Figure INT 8).

3 Trends in Liver Transplant

The demand for liver transplants has continued to decline, likely due to improvements in treatment of hepatitis C. In 2022, the number of adult and pediatric liver transplant candidates on the waiting list declined to 25,328, a decrease of 2.6% from 2021. The total number of candidates has continued to decline since 2016, when the value was 27,839 (Figure INT 1). There has been a smaller increase in new candidates added to the waiting list during the same period. However, in 2022, 13,603 candidates were added to the waiting list, a decrease of 1.6% from 2021 (Figure INT 3) The number of transplants performed increased to 9,527 in 2022, a 3.2% increase from 2021, and this number has increased each year since 2012, when the value was 6,256 (Figure INT 5). Among the cohort of recipients from 2015 through 2017, 1-year and 5-year patient survival were 92.1% and 81.6%, respectively (Figure INT 8).

4 Trends in Heart Transplant

The year 2022 saw 8,707 candidates on the heart waiting list, an increase of 0.5% from 2021 (Figure INT 2). Of these candidates, 5,149 were newly added to the waiting list in 2022, which represents a 1.4% annual increase in new additions to the list from 2021 (Figure INT 4). The number of heart transplants performed in 2022 reached a record high of 4,162, a 7.7% increase from 2021, and has increased from 2,407 in 2012 (Figure INT 6). Among the cohort of recipients from 2015 through 2017, 1-year and 5-year patient survival were 91.7% and 81.1%, respectively (Figure INT 8).

5 Trends in Intestine Transplant

In 2022, there were 347 candidates on the intestine waiting list, a decrease of 4.7% from 2021 (Figure INT 2). Of these candidates, 146 were added to the waiting list in 2022 (Figure INT 4). The number of intestine transplants performed in 2022 was 82, a 14.6% decrease from 2021 (Figure INT 6). Thus, the demand for intestine transplants has continued to decline, likely due to improvements in medical management. Among intestine transplant recipients from 2015 through 2017, 1-year and 5-year survival were 82.4% and 61.7%, respectively (Figure INT 8). This represents the lowest 1-year patient survival among all solid organ transplants.

6 Trends in Lung Transplant

In 2022, there were 4,301 candidates on the lung waiting list, a 2.7% increase from 2021 (Figure INT 2). The year 2022 saw 3,208 new listings, an increase of 1.6% from 2021 (Figure INT 4). The 2,743 lung transplants performed in 2022 was a 6.8% increase from 2021. This a sign of a recovery from the COVID-19 pandemic, because the prepandemic number of lung transplants in 2019 was 2,759 (Figure INT 6). Among lung transplant recipients from 2015 through 2017, 1-year and 5-year survival were 89.0% and 60.5%, respectively (Figure INT 8). This represents the lowest 5-year patient survival among all solid organ transplants.

7 Summary

In 2022, the transplant system set another record for the number of solid organ transplants performed in the country. Over the past decade (2012-2022), the number of kidney transplants increased by 52%; liver transplants, by 52%; heart transplants, by 73%; and lung transplants, by 54%. During the same period, there was a decline of 12% and 23% for pancreas and intestine transplants, respectively, likely due to improvements in medical management for such patients. In 2022, the number of candidates on the waiting list increased for kidney, kidney-pancreas, heart, and lung transplants. In the same year, the number of candidates on the waiting list decreased for liver, intestine, and pancreas alone transplants. In 2022, the number of newly listed candidates increased for kidney, heart, intestine, kidney-pancreas, and lung transplants and decreased for liver and pancreas-alone transplants. The growth in transplants overall was outpaced by the waitlist additions, thereby highlighting the supply-demand imbalance in solid organ transplantation. The increase in the number of organs recovered for the purpose of transplant but ultimately not transplanted for kidney and pancreas also represents an opportunity for improving efficiency in the system. Each organ-specific chapter and the chapters dedicated to specific topics 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.

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 2022 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 2022 Annual Data Report. U.S. Department of Health and Human Services, Health Resources and Services Administration; 2024. Accessed [insert date]. http://srtr.transplant.hrsa.gov/annual_reports/Default.aspx
Abbreviated full citation: OPTN/SRTR 2022 Annual Data Report. HHS/HRSA; 2024. Accessed [insert date]. http://srtr.transplant.hrsa.gov/annual_reports/Default.aspx
Chapter citation: [Authors]. OPTN/SRTR 2022 Annual Data Report: [chapter]. Accessed [insert date]. http://srtr.transplant.hrsa.gov/annual_reports/Default.aspx
Chapter citation for AJT e-supplement available at amjtransplant.org: [Authors]. OPTN/SRTR 2022 Annual Data Report: [chapter]. Am J Transplant. 2024;24([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 2022 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. 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, 2015-2017, 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, 2015-2017, 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, 2015-2017, 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.