Background The decommissioning of hemodialysis machines, particularly in the context of transitioning from hemodialysis to hemodiafiltration, remains understudied despite its importance for sustainable healthcare. This study evaluates decommissioning strategies for hemodialysis machines used by Dutch hospitals, analyzing the economic, social and environmental consequences. Methods A qualitative, exploratory study was conducted through semi-structured interviews with 15 professionals from 11 Dutch hospitals that retired hemodialysis machines. The analysis focused on understanding decommissioning strategies and their economic, social and environmental consequences. Results Five decommissioning strategies were identified: disposal, donation, reuse, sale and recycling/trade-in. Substantial variability and limited formalization in these strategies were observed across and within hospitals. Economic consequences included repair costs, depreciation and resale value. Social consequences were important, yet typically secondary. Environmental consequences were recognized but rarely formalized, although indirect environmental benefits from economically driven repair activities were acknowledged. Conclusions Decommissioning strategies for hemodialysis machines in Dutch hospitals do not use formalized guidelines and are still predominantly shaped by economic drivers. The recognition that each decommissioning strategy entails distinct economic, social and environmental consequences highlights the need for more balanced decision-making. By embedding sustainability principles into hospital policies and standardizing decommissioning procedures, hospitals can move toward more circular and responsible dialysis care.