*Purpose: Use of suboptimal kidneys (SOKs) is not uniform across centers. We hypothesize that creating an aggressiveness report card (ARC) that provides surgeons with timely feedback on their aggressiveness in SOK utilization, along with outcomes of their declined SOKs, has the potential to impact their clinical behavior and potentially increase utilization of SOKs. The aim of this study was to interview primary stakeholders in kidney organ acceptance to inform the creation of these ARCs.

*Methods: We conducted interviews with transplant surgeons across the country to ascertain data needs and the potential impact of an ARC. The interviews were recorded, transcribed, and qualitatively analyzed by one coder using NVivo12. Codes were identified inductively and then organized into themes and subthemes.

*Results: Surgeons interviewed had a median of 9.5 years of practice (IQR 13.8 years). All believed information on the outcomes of kidneys they turned down would affect their clinical behavior. For the turned down kidneys, respondents were most interested in knowing long term graft outcomes (100%), presence of delayed graft function (70%), and recipient post-transplant creatinine trends (60%) (Figure 1A). Respondents also unanimously believed that receiving information on how their aggressiveness in accepting SOKs compares to other surgeons and centers would impact their clinical behavior. The most commonly preferred categories of aggressiveness on which they wished to be compared were KDPI (60%), cold ischemia time (40%), and biopsy findings (40%) (Figure 1B). The majority of surgeons preferred to receive an ARC every 3 months (60%) (Figure 2A) via email (90%) (Figure 2B).

*Conclusions: This preliminary investigation gives insight into surgeon attitudes regarding the potential impact of an ARC. By reporting the most commonly preferred outcomes of declined SOKs, as well as surgeon aggressiveness in utilizing SOKs, an ARC may impact and potentially alter surgeon behavior.

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