*Purpose: Evaluation of multiple transplant candidate referrals is a resource-intensive process that may delay listing and eventually transplanting appropriate patients. In this study, we sought to streamline ineligibility criteria at a single transplant center as a quality improvement initiative to make the transplant listing process more efficient.

*Methods: We evaluated all patients referred to our center for kidney transplants between July 1, 2019, and July 1, 2020. All patients underwent testing consistent with UNOS established minimum listing criteria and were presented at a multidisciplinary transplant selection committee. We analyzed and grouped specific reasons for transplant ineligibility among those patients who were declined for transplant listing.

*Results: Three hundred and ten patients were referred and evaluated for kidney transplant candidacy. Of these, 110 patients (35%) were declined for transplant listing. Medical comorbidities were the reason for ineligibility in 55 (50%) patients (including poor functional status in 32 pts., cardiac disease 10 pts., peripheral vascular disease 6 pts., morbid obesity 4 pts., malignancy 3 pts). Fifty-four patients (49%) were ineligible due to psychosocial concerns (non-compliance 28 pts, travel/family support issues 14 pts., legal issues 10 pts., financial issues 2 pts.). One patient had improvement in kidney function during the evaluation process and no longer qualified for transplant.

*Conclusions: Pre-transplant evaluation is very resource intensive for transplant centers. Detailing and understanding the reasons for ineligibility among referrals may help transplant centers streamline their evaluation processes to identify and list the right patients efficiently for transplant. This is an important quality initiative that every transplant center must consider.

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