*Purpose: As the inactive deceased donor kidney transplant (DDKT) waitlist pool continues to grow, management of these patients has become an increasingly complex administrative undertaking. We sought to characterize waitlist management strategies across centers to better understand how centers approach the inactive waitlist.

*Methods: Transplant centers with an active DDKT program were identified through the OPTN Member Directory. We obtained contact information of the primary team member(s) responsible for waitlist management at each center via phone call or email. Surveys were distributed electronically using Qualtrics Survey Software from October to November 2018.

*Results: We obtained contact information for 247/306 (80%) active kidney transplant centers, and a total of 82/247 (33%) centers responded to our survey. Centers reported a median of 5 (IQR 3,8) pre-transplant coordinators and assistants. 33 centers (40%) reported having 201-500 candidates on their waitlist, and 44 (54%) reported 21-40% of their waitlist consisted of inactive candidates. 38 centers (46%) lacked specific time frames for candidates to complete pre-transplant testing, and 34 (41%) did not have scheduled review of inactive candidates’ statuses (Table 1). Centers differed in their tendencies to list candidates as inactive when considering common reasons for inactive status (Figure 1). While 24 centers (29%) used EMRs and transplant databases for reminders to review candidate status, 28 (34%) relied on spreadsheets or coordinator memory. 24 centers (29%) cited a multidisciplinary approach to candidate status review while 9 (11%) employed strategies to minimize unnecessary reviews, such as prioritizing candidates most likely to receive an offer. When asked to rate their own management of the inactive waitlist, 35 centers (43%) thought their approach was excellent or satisfactory while 47 (57%) were neutral or felt a need for improvement.

*Conclusions: Centers use a range of strategies to manage the inactive waitlist. Further studies on impact of different management strategies on pre and post-transplant outcomes will help identify best practices in waitlist management.

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