*Purpose: After deceased donor kidneys are recovered, they are offered according to UNOS policy and are discarded if no centers in the country would use them. Kidney Care Act mandates to increase the utilization of tdiscarded kidneys. Our study is to examine what factors lead to discard and whether there were discarded kidneys in the One Legacy OPO service area that could be transplanted.

*Methods: In 2019 there were 1,019 kidneys recovered from 552 deceased donors with 740 transplanted and 279 discarded after offers being declined by all local and national centers. Our study cohort, all discards, were subsequently and independently reviewed by 3 local experienced transplant physicians and one surgeon, to identify which kidneys they would have transplanted, assuming they could transplant into any recipient on their list.

*Results: Characteristics of discarded kidneys and associated odds for discard are shown in table 1. Characteristics of 279 kidney discards. %discards’ is the number of discards with that risk factor divided by the total discards. Many kidneys had more than one risk factor. ‘Risk of Discard’ is the number of kidneys from donors with that risk factor from discarded kidneys divided by the number of kidneys with that risk factor in all kidneys. There were 33 kidneys from 22 donors identified by one or more reviewers as potentially transplantable (12%). No reviewer identified more than 15 kidneys as transplantable; 5 kidneys were identified by all 4 reviewers as transplantable. Characteristics of the 33 potentially transplantable kidneys are shown in table 2.

*Conclusions: 1) A small percentage of previously discarded kidneys were considered transplantable in retrospect by our local transplant community2) Increasing utilization from “discarded pools” is not likely to increase kidney transplants by large numbers.3) Biopsy findings of glomerulosclerosis and interstitial fibrosis remained a relative contraindication for all evaluators.4) A systematic approach to setting acceptable donor characteristics, identifying suitable recipients, and providing extensive informed consent, will be required if fewer kidneys are to be discarded.

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