PROJECT SUMMARY Despite a kidney transplant (KT) waitlist of almost 100,000 people, kidneys are recovered from only 10,000 deceased donors annually, resulting in nearly 5,000 waitlist deaths per year. However, there are an estimated 38,000 potential deceased donors per year, and recovery of organs from all potential donors could eliminate the waitlist. In a recent White House Executive Order, the President cited underperformance of organ procurement organizations (OPOs) as a major impediment to recovery of organs from all potential donors. OPOs perform well for "ideal" deceased donors; however, potential improvement lies in the pursuit of suboptimal kidneys (SOKs), such as those from older donors, donors after cardiac death (DCD), donors infected with HIV or HCV, donors with prolonged cold ischemia time (CIT), and donors with elevated terminal creatinine. These organs can be challenging to evaluate, recover, and allocate. Current OPO evaluation metrics are based on averages: a single, all-encompassing number reflecting "performance" that includes both the easy and challenging cases. But the important details get lost in this average. No method exists to provide OPOs with stratified, comparative feedback on their pursuit of SOKs. We previously addressed a parallel challenge, SOK utilization by transplant centers, using a method that can now be applied to OPOs. Our goal is to develop an aggressiveness report card (ARC) for OPOs that provides easily interpretable and clinically relevant stratified feedback. We hypothesize that OPO aggressiveness and performance is a function of subtype of SOK and that feedback will alter OPO behavior, leading to increased understanding and pursuit of SOKs, increased KT, and decreased waitlist mortality. Our approach is targeted and collaborative rather than forced and regulatory, which will improve participation and adoption.