Key PointsQuestionWhat are the national patterns in kidney use and transplant outcomes among adult recipients of kidneys from deceased donors with active or resolved COVID-19?FindingsIn this cohort study of 35 851 deceased donors and 45 912 adult transplant recipients in the US, the likelihood of nonuse of kidneys from active or resolved COVID-19–positive donors decreased over time, with no higher likelihood of nonuse for kidneys from COVID-19–positive donors in 2023. Donor COVID-19 positivity was not associated with worse transplant outcomes within 2 years after transplant.MeaningThese findings suggest that the use of kidneys from donors with active or resolved COVID-19 is safe, with excellent outcomes during medium-term follow-up.