*Purpose: The Organ Procurement and Transplantation Network (OPTN) completed the Collaborative Improvement and Innovation Network (COIIN), a study to increase kidney transplants by reducing risk aversion through a collaborative approach to performance improvement.

*Methods: We evaluated COIIN’s effect on deceased donor transplant rates and offer acceptance practices. Cause-specific Cox proportional hazards models estimated the effect on transplant rates, accounting for candidate characteristics at listing. Logistic regressions estimated the effect on offer acceptance, accounting for candidate and donor characteristics. Transplant rates and offer acceptance practices for programs in COIIN cohorts A and B and not participating in COIIN were estimated for period 1 (pre-COIIN, 1/1/2016-12/31/2016), period 2 (active intervention for cohort A, 1/1/2017-9/30/2017), and period 3 (active intervention for cohort B, 10/1/2017-6/30/2018).

*Results: Cohort A programs had lower transplant rates and offer acceptance in period 1 compared with programs not in COIIN. Transplant rates and offer acceptance significantly increased from period 1 to period 2 for cohort A (transplant rate ratio [TRR], _1.151.24_1.33; offer acceptance ratio, _1.051.15_1.26). Transplant rates increased in period 2 for cohort B (TRR, _1.061.12_1.18), but less than for cohort A (TRR, _1.011.11_1.21).

*Conclusions: Transplant rates and offer acceptance practices were no different for any group in period 3, i.e., after the active intervention for cohort B. COIIN may have increased transplant rates and offer acceptance practices for cohort A, but differences at baseline complicate the interpretation. COIIN deserves further monitoring for sustainability and improvement.

Figure 1. Adjusted transplant ratios.

Figure 2. Adjusted offer acceptance ratios.

« Back to 2019 American Transplant Congress