*Purpose: Background: 20% recovered kidneys are discarded in the US. Southern California has a high number of End-Stage Kidney Disease patients and the waitlist time is one of the longest in the country.

Objectives: In this study we aimed to evaluate outcomes of organs recovered from donors in OneLegacy OPO representing seven counties of the greater Los Angeles area and to identify reasons of local organ decline.

*Methods: We obtained data from UNOS and the Organ Procurement Organization (OPO), OneLegacy for kidneys under their donation service area (DSA) between January 2015 and August 2020. We calculated the local organ decline rate defined as the percentage of recovered organs declined by all centers under the OPO’s DSA and shared outside the DSA. We also evaluated the offer refusal rate defined as organ offers that were refused by centers within the OPO’s DSA.

*Results: Out of 8113 kidneys offered for transplant, 6408 (79%) were refused by centers within the OPO’s DSA at least once before being accepted. 1258 out of 7894 (15.9%) kidneys that were recovered locally within the OPO’s DSA were subsequently transplanted out of the DSA. Out of the 1258 kidneys that were shared, 28 grafts had the composite outcome of primary failure and primary non-function. 219 kidneys were not offered for transplant and were discarded at the time of recovery. The most common reasons for offer refusal were “donor age or quality” (36.8%) and “patient ill, unavailable, refused or temporary unsuitable” (35.3%).

*Conclusions: The local organ decline rate is significant in our DSA. A significant number of kidneys that were declined in this DSA were transplanted and 2.2% had primary non-function. Opportunities for increased utilization of these organs within the service area are being explored.

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