*Purpose: Donation Service Area (DSA) and OPTN Region were removed from pancreas allocation on 3/15/21 and replaced with a 250 nautical mile (NM) fixed circle around the donor hospital with proximity points. The goal of this policy was broader distribution of pancreata, promoting equitable access to transplant.

*Methods: OPTN data were analyzed for pancreas (PA) and kidney-pancreas (KP) candidates, transplants, and donors in the 3.5 months pre- and post-policy (pre: 12/01/20-03/14/21; post: 3/15/21-06/30/21).

*Results: KP and PA transplant volume increased post-policy (KP: 227 vs 281; PA: 37 vs 50). Overall transplant rates increased non-significantly for KP and PA from 102 to 119 transplants per 100 active patient years and 64 to 74 transplants per 100 active patient years, respectively. Non-significant increases in transplant rates were also observed for certain subpopulations including all racial/ethnic groups for KP, and White, Black, and Hispanic racial/ethnic groups for PA. Median time from listing to transplant decreased from 0.44 to 0.35 years for KP recipients, and increased from 0.40 to 0.79 years for PA recipients. Waiting list mortality increases post-policy for KP (6.52 vs 8.32 deaths per 100 patient years) and PA (1.68 vs 2.63 deaths per 100 patient years) were not statistically significant. As expected, more transplants occurred at centers outside the recovering OPO’s DSA after implementation (KP: 32% vs 58%, p<0.001; PA: 57% vs 70%, p=0.29), but the majority stayed within 250NM (KP: 82% vs 86%, p=0.29; PA: 57% vs 60%, p=0.93). Median distance from donor hospital to transplant center increased from 72 (IQR: 9-182) to 98 (24-206) NM for KP and decreased from 199 (107-525) to 147 (65-484) NM for PA. The PA discard rate decreased from 26.6% to 23.3% (p=0.32).

*Conclusions: Early data show alignment with the directionality of KPSAM results used in the policy development in many instances, such as increases in KP transplants, though volumes remain low. PA transplants, expected to decrease in light of the expected increase for KP, have increased, though counts remain small. While more KP and PA were allocated outside the recovering OPO’s DSA, the majority stayed within 250NM. The OPTN Pancreas Transplantation Committee will continue to monitor this policy as data accumulate.

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