*Purpose: The disparity between the supply and demand for kidney allografts is exacerbated by an 18.9% discard rate. It is our aim to determine predictors of kidney allograft discard and to construct an index which can be used to identify and further study high probability discard kidney allografts.

*Methods: In a review of the Organ Procurement and Transplantation Network (OPTN) database, a total of 102,246 potential kidney allograft donors were used in this analysis. The cohort was randomized into two groups. The training set included 67% of the cohort and was used to derive a predictive index for discard comprised of 21 factors identified by univariate and multivariate logistic regression analysis. The validation set included 33% of the cohort and was used to internally validate the Kidney Discard Risk Index (KDRI).

*Results: In 77.3% of the study population, at least one kidney used for transplantation, while in 22.7% both kidneys were discarded. The KDSRI was highly predictive of discard with a c-statistic of 0.89 (0.89-0.91). The bottom 10% had a discard rate of 1.17%, while the top 10% had a discard rate of 88.88%. The three most predictive factors for discard were age, creatinine, and Hepatitis C antibody status.

*Conclusions: We identified 21 factors predictive of kidney discard and used them to develop a KDSRI with a c-statistic of 0.89, making it the most predictive index for discard. This index can be utilized to identify kidneys of high probability discard prior to organ procurement.

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