*Purpose: We studied the transplant surgeons’ effect on accepting or rejecting the deceased donor kidney offers and their subsequent effect on transplant outcomes.

*Methods: There are 4,783 patients currently registered at UCSF Medical Center who are waiting for a kidney donation. When an organ becomes available, it is allocated to the patients who are eligible for transplantation according to the OPTN’s computer generated additive point system. This point system results in a sequence of offers to individual patients. A transplant surgeon sequentially evaluates these kidney offers and determines whether to accept or reject the kidney offer depending on the donor kidney and recipient characteristics. There is extensive literature studying the different organ and patient characteristics and their contribution into these decisions. However, the contribution of the surgeons and how they affect these decisions is largely unexplored in the literature.

We study the local deceased-donor kidney offers to the UCSF Medical Center patients on the OPTN wait list between the years 2010 and 2016. Our model considers a number of recipient variables, donor kidney variables, the characteristics emerging from the match of the recipient and the donor, and the surgeon who made the accept or reject decision. We account for the surgeons’ effect on the decision by creating a dummy variable for each of the surgeon involved in the decision. Using the OPTN DonorNet data, we apply a logistic regression LASSO (least absolute shrinkage and selection operator) model to identify the attributes that significantly contribute into the accept/reject decision of an organ offer. We also study the outcomes of the 678 transplants occurred at UCSF during this period. Using a regression LASSO model, we study transplant outcomes as the creatinine levels measured 3, 6, and 12 months post transplant.

*Results: The LASSO model suggest that the variables whose coefficients are significantly above zero contribute to the prediction of the dependent variables. We find that the surgeon on call, who makes the accept/reject decision, significantly contributes to the accept/reject decision of a kidney offer. However, the attributes of donor such as KDPI score and other comorbidities appear to be more important in the decision process. We also find that the surgeons do not have a statistically significant effect on the transplant outcome.

*Conclusions: Our results suggest that unlike KDPI score and other comorbidities, surgeons’ perception of organ quality do not inform the transplant outcomes, hence it should not affect the decision of accepting or rejecting a deceased-donor kidney offers.

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