*Purpose: Liver donor graft discard rate remained at approximately 10% in the United States despite the critical organ shortage. We sought to understand practice patterns that affect organ offer acceptance so as to help reduce the discard rate of grafts from less than ideal donors.

*Methods: In Fall 2019, individual clinicians anonymously completed a survey distributed via email to determine practice patterns with respect to receiving and evaluating adult liver organ offers.

*Results: A total of 986 individuals in the ASTS membership list were sent an email to complete an online survey with 113 surgeons responding (11.4% response rate). All UNOS regions were represented. The majority (84.42%) of respondents report taking call for multiple organs simultaneously. Over a quarter (26.47%) of respondents report that they examine donor information less carefully between the hours of 22:00 and 06:00. More than a third of respondents (41.6%) consider non-offer related factors such as personal fatigue and staffing as factors in deciding upon accepting offers from less than ideal donors.

*Conclusions: Based on the results determined through this survey, nonclinical information impacts how decisions are made regarding organ offers. Practice patterns are diverse with respect to organ offer consideration, but are bounded in some ways by center protocols and may be affected by non clinical factors. Efforts should be made by OPOs to minimize organ offers outside of daytime hours. Centers should consider ways to minimize surgeon fatigue and improve operative staffing during times of high clinical volume.

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