https://rollingout.com/2026/01/18/america-just-hit-a-kidney-transplant/ (https://rollingout.com/2026/01/18/america-just-hit-a-kidney-transplant/)
America Just Hit a Kidney Transplant Turning Point
A troubling decline in deceased donations is slowing life-saving procedures, and nobody's really sure how to fix it
The number of kidney transplants in the United States fell in 2025 marking the first meaningful decline in decades and the reasons behind it reveal a broken trust system. The Kidney Transplant Collaborative analyzed national data and documented 28,377 kidney transplants in 2025, down 116 from the previous year. That number might sound small until you realize what it represents: 116 fewer people received organs that could extend or save their lives. The drop stemmed from a steeper decline in deceased donor kidneys, which account for about three-quarters of all donations. Living donor kidneys increased, but not enough to offset the loss. More troubling than the numbers themselves is what's driving the decline and how quickly public trust in organ donation collapsed in 2025.
"For the first time in decades, we are seeing a measurable decline in deceased kidney donations even as living donations continue to rise," Dr. Andy Howard, chair of the collaborative, said in a statement. "This is a serious signal for the transplant community and patients will feel the consequences quickly."
The trust breakdown happened fast
Transplant levels stayed stable through the beginning of 2025, then started declining noticeably in June. That timing isn't coincidental. Over the summer, federal officials announced that organ donations could be authorized for patients still showing signs of life. The revelation prompted immediate regulatory tightening including decertifying organizations that procure organs. Media reports about individual cases made things worse. One story involved a woman declared dead for organ procurement who was cut open when doctors discovered her heart was still beating. She survived.
That's exactly the kind of story that destroys public confidence instantly.
The heightened scrutiny "has likely unsettled participants in the deceased donor process," the Kidney (https://en.wikipedia.org/wiki/Kidney) Transplant Collaborative noted. Rather than reinforcing confidence in the system, the environment "may be contributing to hesitation among donors, families, and institutions at a moment when continued growth in deceased donation is critical." The collaborative documented something concrete: thousands of people removed themselves from organ donation lists in August 2025 alone.
This affects real people waiting right now
Over 100,000 people are currently on organ waiting lists. About 94,000 of those are waiting specifically for kidneys. Some people die waiting. Those aren't abstract statistics they're patients running out of time while the transplant system experiences its first meaningful decline in years.
The organ procurement organizations the institutions responsible for coordinating donations appear to have become more conservative as scrutiny intensified. That caution, while potentially understandable, directly reduces the number of organs available for transplantation.
The bigger system problem nobody's addressing
The national transplant system functions as a partnership between organ procurement organizations, the federal government, the United Network for Organ Sharing, and hospitals. It's complex, decentralized, and heavily dependent on public participation. When public trust erodes, the entire system suffers.
The Association of Organ Procurement Organizations acknowledged the problem directly, calling the 2025 transplant decline "alarming" and attributing it to collapsing public trust stemming from "widespread misinformation and confusion about how organ donation works and the role of each stakeholder in the process."
They're essentially admitting that confusion about the system itself is driving people away from participation.
The stakes are existential
What's actually happening is that legitimate concerns about organ procurement concerns that absolutely deserve investigation and regulation are getting tangled with misinformation, creating a situation where public trust collapses faster than solutions emerge. You need public participation for organ donation (https://rollingout.com/2024/09/28/black-community-embrace-organ-donation/) to work. When people lose confidence, they opt out. When they opt out, people die waiting for transplants. That's the direct consequence.
The collaborative and procurement organizations are calling for unity: "We call on all stakeholders in organ donation and transplantation from OPOs to our hospital partners and federal regulators to unite in restoring public trust and strengthening this critical system that has served millions of Americans and their families."
That sounds reasonable until you realize the system needs both trust and transparency, accountability and participation. It needs federal oversight that catches actual problems without creating panic. It needs public education about how donation actually works. And it needs to happen fast because every month that transplant (https://rollingout.com/2025/08/22/edward-drake-20-years-kidney-transplant/) numbers stay low, more people die waiting.
https://medicalxpress.com/news/2026-01-mistrust-linked-deceased-donor-donations.html (https://medicalxpress.com/news/2026-01-mistrust-linked-deceased-donor-donations.html)
Public mistrust linked to drop in deceased donor organ donations and kidney transplants
by Lauran Neergaard
Organ donations from the recently deceased dropped last year for the first time in over a decade, resulting in fewer kidney transplants, according to an analysis issued Wednesday that pointed to signs of public mistrust (https://medicalxpress.com/news/2025-07-donation-scrutiny-disturbing.html) in the lifesaving system.
More than 100,000 people in the U.S. are on the list for an organ transplant. The vast majority of them need a kidney, and thousands die waiting every year.
The nonprofit Kidney Transplant Collaborative analyzed federal data and found 116 fewer kidney transplants were performed last year than in 2024. That small difference is a red flag because the analysis traced the decline to some rare but scary reports of patients prepared for organ retrieval despite showing signs of life.
Those planned retrievals were stopped and the U.S. is developing additional safeguards (https://medicalxpress.com/news/2025-07-donation-scrutiny-disturbing.html?utm_source=embeddings&utm_medium=related&utm_campaign=internal) for the transplant system, which saves tens of thousands of lives each year. But it shook public confidence, prompting some people to remove their names from donor lists.
Dr. Andrew Howard, who leads the Kidney Transplant Collaborative, said last year's dip in kidney transplants would have been larger except for a small increase—about 100—in transplants from living donors (https://medicalxpress.com/news/2025-03-transplant-surgeon-kidney-donor.html?utm_source=embeddings&utm_medium=related&utm_campaign=internal), when a healthy person donates one of their kidneys to someone in need. The collaborative advocates for increased living donations, which make up a fraction of the roughly 28,000 yearly kidney transplants.
With the exception of 2020, when the COVID-19 pandemic was raging, organ transplants have been rising year-to-year. Last year's decline in deceased donors didn't translate into fewer transplants overall: There were just over 49,000 compared with 48,150 in 2024. Transplants of hearts, livers and lungs continued to see gains, according to federal data. Howard said that was likely due to differences (https://medicalxpress.com/news/2025-12-adult-heart-transplantation-western-europe.html?utm_source=embeddings&utm_medium=related&utm_campaign=internal) in how various organs are evaluated and allocated for transplant.
The Association of Organ Procurement Organizations wasn't involved in Wednesday's analysis but expressed alarm, calling on its members, hospitals and federal regulators "to unite in restoring public trust and strengthening this critical system."