Organ allocation for transplantation across the United States is administered by the United Network for Organ Sharing (UNOS). UNOS recently approved a major policy change of the system used to allocate hearts for adult transplant candidates. The main objective of this study is to investigate the impact of the new policy on geographic disparity measured by four performance indicators (waiting time before a transplant, transplant rate, pre-transplant mortality rate, and average distance traveled by donated hearts). The current policy and the new policy were evaluated using the thoracic simulation allocation model. The results show that the new policy improves the median waiting time, transplant rate, and pre-transplant mortality rate. The overall predicted improvement in geographic equity is modest except in terms of waiting time. The findings highlight the need for a targeted approach for donor heart allocation to achieve equal access to heart transplantation in the US.
