*Purpose: The proposed kidney allocation replaces current local and regional by a 250 nautical mile (nm) radius circle from the actual donor hospital (DH) to transplant centers (TC). The policy gives up to two additional allocation points to the nm difference between the DH and TC and add these points to the candidates’ current allocation points consisting of total wait time (WT), DR matching, CPRA, etc. There has been speculation as to how this policy will impact individual TCs volume, especially early in implementation. We performed a simplified simulation of allocation of all deceased donor (DD) kidneys transplanted from DHs to TCs in our surrounding three states: Alabama (AL), Florida (FL), and Georgia (GA) for 5 years using data from the start of the new KAS, Dec 2014.

*Methods: We used OPTN STAR file data Dec 2014 through 2018 to simulate donor kidneys and waiting list candidates. Adult DD kidney alone candidates / recipients with a CPRA £ 80% and with both DH and TC located in AL, FL, or GA from Dec 2014 to Dec 2018 were included. Patients were separated by blood type (BT) to calculate the average number of patients wait listed (WL) and transplanted, number of kidneys transplanted and median WL time each year per TC. Total allocation points were calculated from the difference from TC to DH (2 points maximum) plus WT. The patient with the most total allocation points on the list (WT + distance points) was awarded the next available kidney for each BT. Each TC had new patients listed each year based on prior WL additions including their average listed allocation points per BT. The simulation and statistical analyses were conducted using SAS 9.4.

*Results: Within our 3 state simulation, GA TCs were allocated a large number of AL DH organs per year (n=40). The FL TCs with the largest WL also tended to have longer WT in their areas and attracted more kidneys (Miami and Jacksonville areas). The two centers that gained the most transplants per year gained 32 and 22 transplants each with the greatest decreases at 39 and 27. Median WT at most TCs for each BT increased from baseline to year 5. All TCs within a state developed equivalent WTs by Year 5. The greatest increase in WT at one TC was from 4.2 to 6.8 years for B kidneys.

*Conclusions: Our simulation verified that in the short term, high WT TCs will receive more organs with decreasing median WTs at these TCs with reciprocal increasing WT at the other TCs. Lower WT TCs attract organs as the WT for each BT equilibrates across nearby TCs at year 5.

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