*Purpose: For the majority of organ procurement organizations (OPOs), OPO staff travel to donor hospitals to obtain consent and manage donors, while OPO headquarters (HQ) are the primary site for donor laboratory testing. We hypothesized that donation rates decrease with increased travel time from OPO HQ to donor hospital.

*Methods: Retrospective cohort study from 2011-2018 using two data sources: organ donors per hospital per year, aggregated by county, from the Scientific Registry for Transplant Recipients, and potential donors using data from CDC WONDER of inpatient deaths ≤75 years of age from causes consistent with donation (CALC deaths). We aggregated data into two 4-year periods, 2011-2014 and 2015-2018, as these are periods when OPOs underwent review for re-certification by the Center for Medicare and Medicaid Services. OPOs in the contiguous US were included. We used ArcGIS to calculate driving time from the OPO HQ to each county’s geographic centroid within the donor service area, accounting for traffic. Counties were aggregated into three bands of driving time (≤30, 31-120, and ≥121 minutes). We calculated the donation rate per 100 CALC deaths for each band. Multivariable mixed-effects linear regression models and post-estimation marginal means were used to calculate and compare donation rates adjusted for factors associated with donation rate.

*Results: In adjusted mixed-effects linear models, increased driving time from OPO HQ was associated with decreased donation rates (p<0.001). Nationally, there was a stepwise decrease in donation rates between the three travel time bands during both 2011-2014 and 2015-2018 (Fig. 1). The magnitude of the association between driving time and donation rates varied across OPOs. However, all 56 OPOs analyzed in this study had a decrease in donation rate from the ≤30 to 31-120 minute band, and 55 OPOs had a further drop in donation from the 31-120 to ≥121 minute band (Fig. 2).

*Conclusions: Nationally and within almost every OPO, donation rate decreases as driving time from OPO HQ increases in a dose-response relationship. This suggests that increased travel time to candidate donor may be a barrier to successful organ recovery.

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