*Purpose: In 2018, allocation policy changed with the goal of lowering waitlist mortality by increasing access to donor hearts. We sought to describe the impact of the heart allocation changes on a single organ procurement organization (OPO). We expected to export more hearts, increase travel distance, increase cold ischemic time, decrease time from first offer to acceptance, and to allocate to recipients with higher acuity.

*Methods: A retrospective review of all adult recipient heart transplants recovered from the OPO service area between 10/18/17-10/18/19 were evaluated. Variables of interest included: total number of hearts transplanted, status of recipient, distance to ship, time from first offer to time of acceptance, expected heart yield, and rate of hearts accepted by the local center. Pediatric recipients were eliminated from the data set because we do not have a local center that performs pediatric heart transplants.

*Results: In the Pre Allocation cohort (PRE) 31 hearts were recovered and transplanted to adult recipients. Of those, 13 (42%) were transplanted locally. Our local center accepted 54% of the hearts offered. Average distance to ship was 213.7 miles and average cold ischemic time was 181 minutes. 65% of recipients were classified as Status 1A. The average time from first offer to acceptance was 19 hours. In the Post Allocation cohort (POST) 40 hearts were recovered and transplanted to adult recipients. Of those, only three (7%) were transplanted locally . Our local center accepted 20% of the hearts that they were offered. Average distance to ship was significantly longer at an average of 394 miles and cold ischemic time was also significantly longer at 213 minutes. In this time period 88% of adult donor hearts went to Status 1, 2, or 3 recipients. The average time from first offer to acceptance in this period was 13 hours. Our heart allocation practices did not change significantly in this time period, therefore we attribute the change in heart distribution to be largely due to the allocation policy change.

*Conclusions: Although distance and cold time have increased, sicker patients are being transplanted and we have been able to place more hearts for transplant in a shorter period than before the allocation change. Our yield has also increased as we were able to allocate to aggressive centers sooner, as reflected in a shorter allocation time. The cost/benefit of broader sharing warrants further study.

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