Evaluating environmental sustainability in the transnational basin of the Tumen River (TBTR) is of great significance for promoting sustainable development in Northeast Asia. However, past research has mostly concentrated on a particular environmental element, making it impossible to thoroughly and effectively show the environmental sustainability dynamics in this transnational area. In this study, we attempted to reveal environmental sustainability trends in the TBTR from 2000 to 2021 using the Environmental Degradation Index (EDI) and analyze the driving forces using a geographical detector. It was found that the TBTR’s environmental sustainability decreased significantly, with a degraded region (13,174.75 km2) accounting for 31.01% of the whole area from 2000 to 2021. The dynamics of environmental sustainability on the three sides of China, the Democratic People’s Republic of Korea (DPRK), and Russia have shown significant differences, with the most significantly improved in environmental sustainability being the subregion of China. On the Chinese side, the area that significantly improved in environmental sustainability accounted for 26.19% of the area on the Chinese side, which was 1.17 times higher than that of the DPRK’s side and 1.24 times higher than that of the Russian side. Land use intensity (LUI), land use and land cover (LULC), and population density (PD) were the most dominant driving forces for environmental sustainability dynamics on the three sides of China, the DPRK, and Russia. China, the DPRK, and Russia can improve international environmental cooperation to promote sustainable development in the TBTR and Northeast Asia.