*Purpose: Developed and implemented an innovative kidney & pancreas transplant waitlist management system in order to more effectively and efficiently re-evaluate patients on a transplant center waiting list to ensure ongoing candidate readiness for deceased donor transplants.

*Methods: Waitlisted patients were stratified into a four-tiered waitlist management system. The system estimated probability for receiving organ offers based on United Network for Organ Sharing (UNOS) qualified wait time, blood group, age, calculated panel reactive antibody, organ type, and Hepatitis C consent status. Protocols were developed for comprehensive re-evaluation of candidates based upon tier status. Re-evaluation of each candidate included medical, psychosocial, nutritional, and pharmacological assessment. Transplant readiness was assessed by conducting retrospective chart reviews to determine if the transplant recipient was re-evaluated within 18 months prior to transplant. The transplant readiness of the cohort prior to implementing the tiered system (42 recipients transplanted between 4/1/2015 to 12/31/2016) was then compared to the post intervention cohort (94 recipients transplanted between 1/1/2017 to 8/31/2018). Data was compared with and without identified outliers, which included zero mismatch organs, directed donations, and recently listed patients that did not have the opportunity for waitlist management (i.e. those transplanted shortly after listing due to long UNOS qualified time).

*Results: For the cohort prior to implementation of the tiered system, it was determined that 23 of the 42 recipients (54.8%) were re-evaluated within 18 months prior to transplant. Excluding pre-intervention outliers, it was determined that 28 of the 33 recipients (84.8%) were re-evaluated within 18 months prior to transplant. For the cohort after implementation of the tiered system, it was determined that 84 of the 94 recipients (89.4%) were re-evaluated within 18 months prior to transplant. Excluding post-intervention outliers, it was determined that 81 of the 84 recipients (96.4%) were re-evaluated within 18 months prior to transplant.

*Conclusions: Implementation of the tiered waitlist management system increased the proportion of recipients that were optimized at the time of transplant, as recipients were found to be more up-to-date on pre-transplant evaluation requirements than previous waitlist cohorts.

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