*Purpose: The Acuity Circles (AC) policy in liver transplantation led to broader organ sharing, whereby many organ procurement organization (OPOs) had to coordinate organ offers and donor procurement schedules with a greater number of transplant centers. These changes may have delayed the time from brain death to organ recovery in a variety of ways, including: increased number of possible ‘local’ recipients, logistics in working with new centers, and logistics of travel to for procuring teams from further away. We sought to evaluate the association between implementation of the AC policy and donor procurement timing (time from brain death declaration to cross clamp).

*Methods: Retrospective study using Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) data. We included all brain-dead donors where the liver was transplant and procurement occurred in a donor service area (DSA) with a liver transplant centers. We divided the data into two periods: 8/8/2019-2/3/2020 (pre-AC) and 3/5/2020-8/31/2010 (post-AC), allowing for a 1-month run-in period for centers and OPOs to adjust to the AC policy. We fit multivariable mixed-effects linear regression models (primary outcome: time from brain death declaration to cross-clamp) adjusting for factors associated with donor organ acceptance that may increase time/logistics (e.g., donor age, concurrent thoracic organ placement), and viability (including donor age, BMI, and serum total bilirubin) and performed marginal standardization to calculate the OPO-level measures of time from brain death to cross-clamp pre- vs post-AC.

*Results: In multivariable models, the difference in time from brain death-to-cross clamp time for liver donors increased by an average of more than 2 hours after implementation of AC (beta coefficient: 2.17, 95% CI: 1.37, 2.97; p<0.001). The magnitude of the difference in brain death to cross clamp time pre- vs. post-AC varied across OPOs, however the median time increased in every OPO when there was no current thoracic organ placement, and 55/56 OPOs when there was concurrent thoracic organ placement [Figure].

*Conclusions: Implementation of the AC policy was associated with significantly increased donor delays, as measured by the timing from brain death declaration to cross clamp. Future research is needed to quantify whether these delays impacted graft outcome, OPO costs, ICU bed utilization, and family perspectives on the donation process.

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