*Purpose: Long-distance transport of deceased donor hearts has been associated with reduced organ utilization rates and risk of inferior outcomes. One U.S. Organ Procurement Organization’s (OPO) donation service area (DSA) includes a large state with no transplant programs within ~900 miles of any donor hospital, and with an average of 22 brain dead donors per year over the five-year period from 2014 to 2018. In 2018, this state had the second highest rate of organ donors per 10,000 deaths of any state in the U.S., at 71.7 vs. the U.S. rate of 38.1. Hearts allocated from this state require long-distance transport, which extends cold ischemic time and increases the likelihood of organ refusal. We sought to study the impact of long-distance transport on heart utilization rates and transplant outcomes.

*Methods: We conducted a retrospective review of brain dead donors (BDD) from 2014-2018 utilizing OPO and Scientific Registry of Transplant Recipients (SRTR) data. A comparative analysis of heart utilization rates and one-year patient outcomes was completed. Donors were categorized into three groups: Group A includes donors from the remote state, Group B includes donors from the remainder of the OPO’s DSA, and Group C includes all other U.S. donors. Observed to expected heart utilization ratios were compiled using 2017-2018 SRTR data, while one-year patient survival rates for Group A and B utilized UNOS TEIDI data (2014-2018) and Group C utilized SRTR data (01/01/2016- 06/30/2018). Donor hearts transplanted in Canada from Groups A and B (n=15) were excluded from the one-year patient survival assessment.

*Results: Donor heart transport distance from Group A ranged from 1,324 to 2,366 (x̅= 1,473) miles. The O:E heart utilization from BDD (using the SRTR organ yield calculator) was better than expected in Group A as well as Group B, despite the long transport distances in Group A. Unadjusted BDD heart utilization rates in Group A were higher than Group C, while Group B’s were significantly (p <.05) higher than Group C (Table 1). One-year patient survival was equivalent in all three groups.

*Conclusions: Remote donor location and corresponding long-distance transport of deceased donor hearts were not associated with decreased utilization nor inferior one-year patient outcomes over the five-year study period. These findings demonstrate that high donor heart utilization rates and acceptable heart transplant outcomes are possible with routine long-distance transport of deceased donor hearts.

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