Project Summary Organ transplantation is the optimal treatment for end stage organ disease and results in improved patient survival and quality of life. Black patients have rates of end stage organ disease nearly three times that of white patients yet comprise only 20% of organ transplant recipients. The transplant selection process is not standardized across transplant centers and therefore health system and transplant center processes may influence access to transplant. Further, national transplant data collection and monitoring exclude the transplant selection process. The overall objective of this proposal is to identify, characterize, and develop interventions to improve access to organ transplant via consistent health system and transplant center processes of care. Our is that lack of standardization and inconsistent care delivery throughout each phase of the transplant selection process creates obstacles to transplant access. This project will quantify the extent of patient elimination in the screening, evaluation and committee decision phases of the transplant selection process using electronic health record data (aim 1), Characterize process vulnerabilities in screening, evaluation and committee decision phases of the transplant selection process that impede transplant access (aim 2) and design and pilot a toolkit for use by transplant centers to improve transplant access. This results of this project elucidate the contribution of inconsistent health system and transplant center processes of care to creating and exacerbating patient difficulty with accessing organ transplant. The research and additional knowledge and skill development will form a strong foundation for the candidate’s transition to an independent investigator independent investigator developing and testing interventions to improve access to organ transplant.