The Irish Kidney Association has described the past year as "disappointing and concerning" for people awaiting kidney transplants.
There were 63 deceased organ donations in 2014 - the lowest yearly rate in recent times.
The association also said the target of 50 live kidney donations was not achieved, despite the availability of donors and recipients.
In a statement, the body also singled out Beaumont Hospital in Dublin for concern, saying its infrastructure was not adequate to advance kidney transplantation.
"The hospital has failed to commission an extra operation theatre and it is now short of transplant surgeons," the association said in a statement.
However, it said the Mater Hospital performed a record number of 49 transplants - 31 lung and 18 heart - and should be congratulated.