*Purpose: To increase the number of patients benefiting from a liver transplant, a university transplant program instituted a weekly review meeting of the transplant surgeons of offers turned down for patients in its program but accepted elsewhere. We review the impact of the first year of this strategy.

*Methods: Using the Report of Organ Offers from UNOS, offers turned down by our institution but used at other institutions for match runs executed between 6/1/2016 till 05/30/2018. We collected primary refusal codes and sequence number of the actual recipient. Offers were excluded if the offer was a split liver, for a candidate already or being transplanted, for candidates needing two organs but offered only one, or a liver accepted for another candidate in our program. The surgeons began reviewing offers weekly from 6/1/2017 onward. Outcomes for patients transplanted in the year preceding weekly meetings were compared to outcomes of patients transplanted in the first year of the meetings.

*Results: In the year before instituting the weekly meeting, 448 donors were turned down but transplanted elsewhere. 69 adult liver transplants were performed. During the year with weekly meetings, 97 liver transplants were performed, and 440 donors were turned down and used elsewhere. 396 were reviewed by the surgeons. The most common three refusal reasons were “Donor Age or Quality” (64%) and “Patient ill, unavailable, refused” (16%), and “Organ Preservation” (7%). On average, these donors were accepted for candidates 238 sequence numbers lower on the match list than our center’s first sequence number. The 90-day graft survival, 93 vs 94% and the 1-year graft survival, 91 vs 92%, at the program of each year were not significantly different. Interestingly, the 90-day graft survival of organs used elsewhere was 93 and 95%, respectively, for pre- and post-implementation years.

*Conclusions: A group approach to reviewing organ turn downs led to weekly discussions of potential missed transplant opportunities. After implementation, there were more offers, fewer organs turned down, and more transplants performed. While follow-up is limited and data entry lags, the graft loss of organs transplanted elsewhere was low. While this may suggest that more of these donors could have been used with a similar rate of graft loss, the organs turned down may have been placed in patients with lower MELDs or more local. Matching donors to appropriate recipients may be crucial for success. In both years, the high ratio of offers to transplants suggests that a great deal of work is non-billable.

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