*Purpose: Hospitals likely fail to refer many medically eligible potential deceased donors to OPOs. As such, increasing eligible referrals may increase the donor pool. We hypothesized that implementation of iReferral^SM, an automated and electronic referral platform, would be an effective method of circumventing the challenges faced with the current phone-based referral system.

*Methods: To better understand the impact of the iReferral^SM system on referrals, we conducted a retrospective study of all deceased donor referrals (n=1409) to three Texas hospitals January 2016 – August 2020. We used Poisson regression to analyze changes in the number of referrals following deployment of the iReferral^SM system in October 2018, overall and for various subgroups, adjusting for seasonality and secular trends.

*Results: After implementation of iReferral^SM, the number of patient referrals increased from median (IQR) 14 (12-18) to 36 (31-43) (p<0.001), representing a 70% total increase per month (IRR _1.38 1.70 _2.10 p<0.001) (Figure 1). This increase was seen across various subgroups including patients <50 (IRR _1.07 1.73 _2.81 p=0.02) and >50 years old (IRR _1.36 1.72 _2.16 p<0.001), and brain dead patients (IRR _1.43 1.76 _2.16 p<0.001). Median (IQR) hours from admission to referral decreased from 60 (13-157) to 30 (7-152) (p<0.001). The number of patients whose families were approached for consent doubled (IRR _1.12 2.03 _3.65 p=0.02). The number of donors per month was 26% higher than pre-iReferral^SM, though the difference was not statistically significant (p=0.3).

*Conclusions: After the implementation of an automated and electronic donor referral, the rate of deceased donor referrals increased substantially, and the number of patients whose families were approached for consent doubled. Automating the process at these key upstream steps in the deceased donor process may increase hospital and OPO efficiency and donor referrals.

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