The International Journal of Health Planing and Management, v. 33, n. 4, pp. e1067-e1087. Abstract: The Brazilian Public Health System, facing a national economic and political crisis, operates with tight budgets and poor physical infrastructure. Among the services it delivers, organ transplantation represents a complex process wherein inefficient resource allocation is a relevant issue. This study examines the technical and scale efficiency of the Brazilian public services in kidney transplantation, assessing the conversion of physical and labor inputs into kidney transplants using data envelopment analysis. This longitudinal analysis used a secondary database from the Brazilian Registry of Transplants having, as a unit of analysis, 23 Brazilian states that performed kidney transplants from 2013 to 2015. The Malmquist index is applied to examine productivity changes. Data were adjusted per million of population, and factors were extracted by principal component analysis. The results indicate that most states operate in a technically inefficient manner, resulting in a low mean efficiency score. Overall efficiency worsened during the analyzed period, and there was a significant disparity in performance between states, with higher scores in the South and Southeast—the most developed and wealthiest regions—than in the North and Northeast. The results provide managerial insights into the delivery of organ transplantation by the Brazilian public services on both the national and state levels, helping to identify opportunities for better resource allocation in this activity. Given the scarcity of studies that systematically assess and benchmark organ donation and transplantation, this work represents an innovative context of application and may be useful for the community of relevant policymakers, academics, and health professionals.