Abstract: Hypertensive donor kidneys have become a major source for kidney transplantation in China. Due to the complication of chronic kidney lesions, such organs are usually classified as marginal grafts. At present, the lack of accurate and non-invasive methods for evaluating donor kidney quality leads to a high discard rate of such kidneys, which further exacerbates the problem of organ shortage. Exosomes are extracellular vesicles that are rich in cell-specific proteins, nucleic acids, lipids and other substances. They participate in intercellular signal transmission and have good stability in circulation and tissue fluid, making them promising novel biomarkers for evaluating renal injury. Therefore, this article reviews the application status and challenges of hypertensive donor kidneys, analyzes the advantages and limitations of existing evaluation methods, and discusses the application value of exosomes in hypertensive renal injury and donor kidney quality evaluation from the perspectives of proteomics and transcriptomics. The aim is to find an early, non-invasive and accurate method for donor kidney quality evaluation, reduce the discard rate of donor kidneys, improve the efficacy of clinical transplantation, and optimize the clinical application strategy of hypertensive donor kidneys.