A growing supply of donor lungs is being recovered — and discarded.
A registry-scale audit that sizes an addressable gap in U.S. lung transplantation, and locates precisely where an objective CT-based suitability read would act.
Evidence base: OPTN/UNOS STAR file, Dec 2025 release — the complete U.S. transplant registry. Deceased-donor & thoracic tables; lung counts are per-lung (recovered positions).
14.4%2025 lung discard rate
More than 1 in 7 donor lungs recovered for transplant in 2025 was discarded — up 5× in two decades. The discards concentrate in identifiable marginal-donor groups and turn on one dominant, subjective reason: "poor organ function."
01 · Evidence base
Registry-scale, adequately powered
Findings draw on the entire U.S. registry, not a single-center series — the sample sizes below establish statistical power for every stratified estimate that follows. Our imaging work links a well-characterized donor subset to chest CT.
320,420
Deceased donors — all organs
59,854
Lung donors — ≥1 lung recovered
60,952
Lung recipients — transplants performed
9,258
CT-linked donors — imaging cohort
02 · The unmet need
Quantifying the discarded supply
Against a persistent waitlist, 113,076 lungs were recovered intending transplant. Most were used — but a rising share were not, representing organs procured at cost and then lost.
Recovered lungs — transplanted vs. discarded Transplanted Discarded
103,879 transplanted
9,197
113,076 lungs recovered for transplant8.1% discarded overall · 14.4% in 2025
03 · Where the risk concentrates
The discards are not random — they cluster
Stratifying the discard rate identifies exactly which donors drive non-utilization. Donation-after-circulatory-death and older donors — the marginal organs where an accept/decline call is hardest — carry sharply elevated rates. Blood type is nearly flat, ruling out allocation-logistics as the main lever.
By donor type — DCD vs DBD
DCD lungs are discarded at ~5× the DBD rate (n = 4,088 DCD lung donors).
By donor age band
A steep monotonic gradient — 65+ donors triple the youngest band.
By ABO blood typenearly flat — 7.9% → 8.7%
Interpretation for intervention design: non-utilization concentrates in the borderline-organ population (DCD, older donors) where the decision is a judgment call — the population an objective CT read is positioned to reclassify. It is not primarily a matching/logistics problem (ABO is flat).
04 · The decisive reason
One subjective call dominates
Reason codes on discarded lungs, full registry (coded n = 6,355). The leading specific reason is a qualitative organ-quality judgment — the target of an objective imaging biomarker.
Discard reason — full registry
■ Organ-quality reasons a CT read can inform. "Other, specify" shown muted.
CT cohort — same rank order
Reason
n
%
Poor organ function
348
30.3
Diseased organ
105
9.1
Anatomical abnormality
102
8.9
No recipient located
71
6.2
Organ trauma
36
3.1
Donor medical history
33
2.9
Biopsy findings
27
2.3
Other, specify
348
30.3
~48% of coded discards — poor organ function, diseased organ, anatomical abnormality — are image-assessable organ-quality calls. This is the mechanistic entry point for VitalMatch's CT model.
05 · Trajectory
Both the rate and the absolute loss are climbing
Discard rate = discarded ÷ recovered-for-transplant, by donor recovery year. Recovery volume is rising and the discarded fraction is rising, so the absolute number of wasted organs compounds — the addressable market grows every year.
Discard rate by recovery year Full STAR CT cohort
Absolute lungs discarded per year — full registry17× since 2005
Same x-axis as above. 2025 is a partial year. Continuous-distribution/CAS allocation began March 2023; expanded DCD recovery and ex-vivo perfusion enlarge the recovered-but-marginal pool.
▸ data table
Year
Recovered
Discarded
STAR %
CT %
06 · Significance
The case for objective donor-lung assessment
~48%
of coded discards are image-assessable organ-quality calls
30.3%
DCD discard rate — 5× DBD; the growth pool
17×
rise in lungs discarded/yr (66 → 1,119)
The gap is large, growing, and concentrated where judgment is weakest. Non-utilization is driven by subjective "poor organ function" calls on exactly the marginal organs — DCD and older donors — that an objective CT read is designed to reclassify.
VitalMatch targets this decision point directly: a CT-based donor-lung suitability score, validated against 72-hour primary graft dysfunction, that can either rescue usable organs mistakenly declined or spare futile recoveries — precisely where the volume is compounding.