IKA calls for urgent investment in organ donation

Transplant numbers are in decline.

Preliminary year-end figures published by the Organ Donation Transplant Ireland Office (ODTI) of the HSE today reveal a decline in organ donation and transplant numbers in Ireland in 2025.

In the context of an aging population and the continued growth in Chronic Kidney Disease,[1] the Irish Kidney Association (IKA) is calling for immediate attention and coordinated investment across our healthcare system to address the significant increased demand on services.

As a patient representative body, the Irish Kidney Association recognises that this decline in donation and transplant activity has profound implications for the growing number of people in Ireland living with organ failure and their families.

Table 1: Organ Donation & Transplantation Activity (Ireland) 2021-2025

• 16 lung transplants were carried out due to one being imported.

From the outset, we wish to express our deepest gratitude to organ donors and their families, whose extraordinary generosity in the most difficult of circumstances continues to give the gift of life to others. Their selfless decisions transform lives and reflect the very best of human compassion. We also acknowledge the dedication of transplant coordinators, surgeons, and all healthcare professionals who work tirelessly to make transplantation possible.

In June 2025, Part 2 (Transplantation) of the Human Tissue Act (2024) commenced. Introducing an opt-out register, altruistic living kidney donation and other protocols for the safe management of organ donation for transplantation, the legislation is a positive step forward, providing a foundation upon which to build a service that can see Ireland return to the upper tier of countries in Europe when it comes to transplantation. Drawing on international experience, this will require expanding the current living kidney donor programme, including the introduction of altruistic donation as provided for in the Human Tissue Act 2024, and continue to embrace and develop the use of organs from donors over the age of 60.[2]

The reality facing our healthcare system is stark. The number of people requiring dialysis continues to rise significantly, placing unsustainable pressure on patients, families, and healthcare resources.

The case for urgent investment is clear

There are almost 700 people currently active on the waiting lists for organ transplants, 540 or almost 80% of these requiring a kidney transplant – year end 2024. This 540 accounts for approximately 20% of the total number of patients currently on kidney dialysis[3]. At the end of 2024, 2,581 people were on dialysis in Ireland – more than three times the 821 people who were receiving dialysis treatment in 2000. Dialysis is already costing the HSE more than €300 million per year[4] underscoring the critical importance of prevention and early intervention.

Chronic Kidney Disease affects approximately one in ten of the general population in Ireland[5]and is on course to be the fifth leading cause of death globally by 2040. Crucially, early identification and effective management of kidney disease can slow or prevent progression to end-stage renal failure, reducing the number of people who will require dialysis or transplant.

Treatment options for kidney failure

For those who do reach end-stage kidney/renal failure, treatment options matter. Successful kidney transplantation offers patients dramatically improved quality of life, better long-term health outcomes, and is significantly more cost-effective than long term dialysis treatment. Yet Ireland’s current decline in transplant numbers means more patients are facing years on dialysis while waiting for a life-changing transplant.

The IKA is calling for urgent action in four key areas:

1. Publication of the complete HSE Internal Review outlined in the Medical Independent report of December 17^th 2023[6]and the development of “a formal strategy to quantify the requirements for transplantation services and an increase in critical care capacity to meet the requirements for all patients” as recommended in the Report.

2. Building on the foundation provided by the commencement of Part 2 (Transplantation) of the Human Tissue Act (2024)[7] in June this year, there is need to learn from the experience of other countries and put funding in place to deliver the protected resources needed to develop the national organ donation and transplant services in areas such as living donation (including altruistic kidney donation) and the use of ‘extended criteria donors’.[8]

3. Expansion of the current NOCA Potential Donor Audit beyond the six hospitals currently being measured to include all hospitals with the potential for organ donation, with timely publication of results.[9]

4. Implementation of the government’s commitment to add Chronic Kidney Disease to the Chronic Disease Management Programme being delivered in primary care.[10]

The time to act is now. Every delay means more people facing the physical, emotional, and financial burden of dialysis, and fewer benefiting the transformative benefits of transplantation. Investment in prevention, early intervention, and a robust organ donation and transplantation infrastructure is not just fiscally responsible, it is a moral imperative.