*Purpose: Over 100,000 candidates are listed for kidney transplant in the United States, yet less than 20,000 patients are transplanted annually. In 2013, over 2,500 deceased donor (DD) kidneys were discarded (17% of total recovered). More than 50% of kidneys with Kidney Donor Profile Index (KDPI) scores of >85 are not utilized. In our region, candidates wait 6-8+ years for a deceased donor and risk of death or delisting exceeds likelihood of transplant for older candidates. In February 2018, uniform deceased donor acceptance criteria were created at our center to increase utilization of high KDPI and acute kidney injury (AKI) kidneys in candidates with no living donors, short wait-time and high predicted wait-list mortality.

*Methods: DD organ offer acceptance rates and total transplants were compared between November 2017 – Feb 2018 (PRE) and March – June 2018 (POST) to assess impact of DD acceptance criteria. For transplants POST acceptance criteria implementation, delayed graft function (DGF), GFR (ml/min) at 1 and 6 months post-transplant, and biopsy-proven acute rejection (BPAR) by 6 months was examined.

*Results: Deceased donor offer acceptance rates improved by 11% (5.66% PRE versus 6.26% POST) and total deceased donor transplants increased (30 PRE versus 49 POST) after implementing deceased donor acceptance criteria. In the POST period, sixteen kidneys were accepted that would have been declined prior to implementation of criteria. These kidneys were identified by high sequence (HS) number of >50 (range 94-3774). Of these kidneys, 7/16 were AKI donors (terminal sCr >3 or dialysis) and 5/16 were KDPI >50 (range 56 – 82). Thirty-three deceased donor kidneys were accepted with sequence number <50 (LS), none were from AKI donors and KDPI range was 6 - 86 (average 44.3). Outcomes in HS kidneys were comparable to LS kidneys for DGF (24% HS versus 34% LS), eGFR at 1 month (50.0 HS versus 46.7 LS), eGFR at 6 months (57.5 HS versus 54.2 LS), BPAR at 6 months (6% both groups) and median length of stay (4 days HS versus 5 days LS). Duration of pre-transplant dialysis (1.9 yr HS versus 5.8 yr LS) and time on waitlist (2.9 yr HS versus 6.8 yr LS) was significantly shorter for recipients of HS kidneys.

*Conclusions: Uniform deceased donor acceptance criteria can improve utilization of high KDPI and AKI kidneys for select recipients with otherwise limited opportunity for transplant. Short-term outcomes are encouraging and support continued efforts to reduce organ discard rates.

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