*Purpose: In February 2020, a new policy for liver allocation was instituted in an effort to reduce geographic disparity in median MELD at transplant. To accomplish this, the use of geographic prioritization based on Organ Procurement and Transplantation Network (OPTN) donor service areas (DSAs) and regions was abandoned in favor of prioritization incorporating acuity circles around the donor hospital. Modelling for acuity circle-based allocation prior to policy implementation demonstrated a significant increase in travel time and travel distance, which may affect the cost of procurement and organ cold ischemia time. The purpose of this study was to assess this impact at our OPO and transplant center.

*Methods: A retrospective analysis was performed that included all liver procurements managed by the Louisiana Organ Procurement Association (LOPA) and all liver transplant recipients at Ochsner Health between 1 January 2019 to 12 December 2020. A comparison of logistical considerations pre- and post-policy implementation were evaluated. Differences were determined using Welch t-test in R with a 95% confidence level as the cutoff.

*Results: For the study period, a total of 246 livers were allocated by the OPO prior to the change in allocation policy compared to 188 livers after. Based on donor service area, the percentage of livers allocated to local recipients pre-policy change was 73% compared to 51% post-policy (p<0.001). The mean transport distance for livers allocated by the OPO pre-policy was 195 miles compared to 213 miles post-policy (p=0.45). At Ochsner Health, for the same period, 221 liver transplants were performed pre-policy and 148 liver transplants post-policy. Based on donor service area, 53% of recipients received a local donor pre-policy compared to 46% post-policy (p=0.17). The mean transport distance pre-policy was 260 miles compared to 273 miles post-policy (p=0.67). Finally, the mean cold ischemia time for the donor liver was 310 minutes pre-policy compared to 305 minutes post-policy (p=0.49).

*Conclusions: Even with modeling to suggest a significant increase in transport distance as a result of the new liver allocation policy, our data suggest that did not occur for our transplant center or for livers allocated to other centers by our OPO. This is despite a significant reduction in the percentage of organs allocated to local recipients. Similarly, we did not observe a change in cold ischemia time for livers transplanted at our center. It is likely that the effect of this policy on transport distance will be highly variable based on transplant center location and the geographic distribution of other centers in proximity. As a result, the burden of increased transport time, increased transport cost, as well as the possibility of increased cold ischemia time will impact transplant centers differently.

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