Many Moving Parts: New Transplant Allocation Models Are Associated With Increased Organ Travel and Potential Climate Implications.

BACKGROUND: Organ allocation has recently changed to acuity circle (AC)-based policies. This study aimed to quantify changes in travel distance and potential environmental impacts of AC policies. METHODS: Data were obtained from the Scientific Registry of Transplant Recipients for each solid organ for an equidistant window before and after AC implementation. We calculated the distance between the donor and recipient hospital for each organ. We used an interrupted time series model to calculate excess travel distance after AC along with associated carbon emissions. RESULTS: We analyzed travel distance for 226 731 deceased donor organs. There was a significant increase in total excess distance traveled: 1.5 × 106 miles for lung, 3.1 × 106 for heart, 2.2 × 106 miles for liver, and 3.2 × 106 miles for kidney. This led to increased estimated carbon emissions associated with transport ranging from: 175.7 to 193.4 kg CO2e per lung, 291.7 to 312.5 kg CO2e per heart, 114.9 to 131.7 kg CO2e per liver, and 0.2 to 5.3 kg CO2e per kidney. CONCLUSIONS: Our findings quantify an increase in total distance traveled and potential carbon emissions after AC implementation. Environmental impacts of allocation policies should be considered, especially with upcoming continuous distribution.