*Purpose: The Organ Procurement and Transplantation Network (OPTN) proposed a new national deceased donor kidney allocation policy that removes donor service area and OPTN region as geographic units of allocation from existing policy to comply with the OPTN Final Rule. The new proposal also prioritizes prior living donors and pediatric candidates in the first unit of allocation, immediately below highly sensitized 100% cPRA candidates.

*Methods: The Scientific Registry of Transplant Recipients simulated kidney distribution under various new policy scenarios compared with current allocation policy. The new policy scenarios simulated 3 different-sized concentric circles of 150, 250, and 500 nautical miles (NM) from the donor hospital and linearly assigned proximity points within and outside the circles to minimize organ travel distance and associated effects on logistics.

*Results: Figure 1 describes the distribution of organ travel distance. The size of the concentric circles was the most important determinant of travel distance. Proximity points affected travel distance within but not outside the circle. Transplant rates increased for pediatric, female, African American, Latino, and highly sensitized (cPRA >80%-99%) candidates, and for candidates on dialysis >5 years. Transplant rates decreased slightly for non-metropolitan candidates and candidates with adult EPTS score 0%-20%.

*Conclusions: Simulations of new proposed kidney policy show improved access to transplant for several vulnerable populations, and that proximity points effectively limit travel distance. Figure 1: The different scenarios are described by circle size for kidney transplants and proximity points for candidates within and outside the circle. BL represents the baseline or current allocation policy with additional priority for local pediatrics. Step 150/250 represents constant proximity points up to 150/250 NM, then declining linearly to zero at 500 NM from the donor hospital.

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