*Purpose: Increased Risk Donors (IRDs) are a significant proportion of the deceased organ donor pool but may be declined by patients on the liver transplant waiting list due to various factors. We conducted a survey of patients with end-stage liver disease awaiting a liver transplant in order to determine the factors leading to the acceptance of an IRD organ, and what strategies we could use to better inform and increase this rate of acceptance.

*Methods: Adult liver transplant candidates who were outpatients completed a survey consisting of 51 questions on a 5-point Likert scale, with categories related to demographics, knowledge of IRDs, and likelihood of acceptance.

*Results: A total of 150 transplant candidates completed the survey (age 19-80 years), with the majority (84.0%) of patients being on the waiting list for less than 3 months. Male patients constituted 67.3%. Many patients (58.7%) had post-secondary education. Only 23.3% of patients already had a potential living donor and 58/144 (40.3%) were not optimistic to receive an organ in the next 3 months. Overall IRD organ acceptability was 41.1% whereas 26.2% would decline an IRD organ. Women were more likely to accept an IRD organ than men (54.3% vs. 34.7%, p=0.02). Those who had college education or higher tended to have lower IRD organ acceptability (28.3% vs. 47.4%, p=0.07). Acceptability of an IRD organ also increased as the specified transmission risk of HIV or HCV decreased (p<0.001). Patients were also more likely to accept an IRD organ if they were educated on the benefits of IRD organs (Figure 1) eg, knowledge that an IRD organ was better quality than non-IRD increased overall acceptance from 41.1% to 63.3% (p<0.001).

*Conclusions: Our survey provides insight into transplant candidates that would benefit from greater education on IRD organs. Strategies targeting specific educational points are likely to increase acceptability.

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