*Purpose: Many deceased donor kidneys remain unused in this country. The UNOS formed Collaborative Improvement and Innovation Networks (COIIN) to tackle this issue, in which our center participated. For this study, we hypothesized that we could increase the percentage of listed patients who consented for deceased donor kidney transplant with kidney donor profile index (KDPI) greater than 85% at our institution from 6% to a goal of 20%. We did this in a systematic fashion so that the outcomes could be sustainable.

*Methods: Using a team approach between transplant nurse coordinators, quality manager, nephrology and surgery, we identified the barriers and current state. We then generated rapid cycle Plan, Do, Study, Act (PDSA) projects, measuring our progress weekly. Finally, after completing our COIIN participation, we tracked the sustainability of these PDSAs.

*Results: We developed several PDSAs: reconciliation between our transplant database and the OPTN Donor Net listing; development of patient inclusion criteria for high KDPI kidneys; development of patient education tool (handout); provider engagement strategies; patient exposure to high KDPI kidney education at initial evaluation and re-evaluation; and, adding high KDPI as a distinct category in our weekly selection committee agenda and listing checklist.

Consent rates for KDPI greater than 85% started at 6% in October 2017. By the end of December 2017, it increased to 10%. COIIN participation ended in June 2018, but we continued to measure the rates monthly until December 2019. We were able to sustain the consent rate of 25%. Reconciliation remains at 100%.

*Conclusions: Consistent provider and patient education and clearly defining the inclusion criteria for KDPI greater than 85% led to increased consent rate for patients on the kidney transplant list. The next step will be to monitor the number of high KDPI transplants performed over ensuing several years to determine whether these interventions impacted deceased donor transplantation and offer turndown rates.

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