*Purpose: Current policies in the U.S. allow patients to register at multiple organ donor service areas (DSAs), provided they have physician approval and can cover additional costs. The ability to register in multiple DSAs may impact the waiting list size, time on the waiting list , and patient mortality. An agent-based queuing model was developed to analyze these potential effects.

*Methods: An agent-based queuing model analyzed the impact of multiple registrations on the transplant waiting list for deceased donors. Simulated patients are added to the waiting list where they wait for a transplant and then eventually receive a transplant or die while waiting. The model used 2017 kidney transplant and waiting list data of each DSA to parameterize a simulation where a proportion of the patients on the waiting list are advantaged and are able to register in multiple DSAs. Each DSA has a simplified queue of patients waiting for a transplant and simulated patients in the model that are advantaged can register for up to four additional DSAs as secondary waiting lists. They select the additional queues by choosing to register in the area with the highest deceased donor transplant to waiting list size ratio. The model runs over a 20-year time span with different proportions of advantaged patients.

*Results: (1) Allowing multiple registrations decreases the overall patient mortality, but increases the average time patients spend waiting for a transplant; (2) patients that have multiple registrations receive proportionally more transplants; (3) advantaged patient mortality is lower; and (4) with approximately 40% advantaged patients in the simulation, deaths and waiting time reaches a steady state. Large disparities exist between waiting times and mortality rates on the waiting list across DSAs, and the disparities decrease as the proportion of advantaged patients in the system increase, which is beneficial to some areas and detrimental to others.

*Conclusions: In the simulated transplant system, allowing multiple registrations decreases mortality and increases the time patients spend waiting for a transplant; patients with multiple registrations benefit the most, especially when the make up a low portion of the waiting list population (&lt40%). At a local level, disparities in waiting list time and patient mortality across regions decrease as there are more advantaged patients in the population, having a negative impact on DSAs with high transplant rates and low death rates.

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