LAUSR

, The new kidney allocation policy implemented in March 2021 has replaced the traditional donation service areas (DSAs) boundaries with a single 250-nautical mile circle centered around the donor hospital to decrease geographic disparities in waiting time for deceased donor kidney transplantation (DDKT) (1). Despite the extensive discussion about the policy development and simulation models for potential consequences (2 – 4), few studies have quantitatively investigated the practical impacts of this redistricting change on transplant center-level and organ procurement organization (OPO)-level practices. An early evaluation of a large rural transplantation program in the East Coast found that the new kidney allocation policy has led to an increase in Kidney Donor Pro fi le Index (KDPI) of donors with longer cold ischemia time (CIT), leading to higher delayed graft function (DGF) rates (5). As a large transplant center located in the Midwestern United States, in this study, we evaluate the impacts of the new allocation policy on our transplant center and its OPO, Mid-American Transplant. This is