Truncated OPTN Regions
OPTN (the Organ Procurement and Transplantation Network) divides the US into 11 geographic regions for organ allocation. Two of those regions are geographically truncated — bounded by ocean or international border on multiple sides — which materially affects how donor livers reach patients.
Region 1 — Northeast (CT, ME, MA, NH, RI, VT, eastern VT)
- Bordered by Atlantic Ocean to the east and Canada to the north.
- Donor catchment is roughly a half-circle, not a full radius.
- Local donor supply per listed patient is structurally lower.
Region 6 — Pacific Northwest (AK, HI, ID, MT, OR, WA)
- Bordered by Pacific Ocean to the west and Canada to the north; Alaska and Hawaii are noncontiguous.
- Even sparser donor catchment per listed patient than Region 1, plus the geographic barriers to interstate organ transport.
- Patients listed only in-region often see the longest waits in the country.
What this means for caregivers:
- If you live in Region 1 or 6 and your in-state center has long waits, dual-listing at a center in a less-truncated region (e.g., Region 7, 10, or 11) is worth discussing.
- Dual-listing requires evaluation at the second center, your insurance, and travel logistics — but the time-to-transplant difference can be substantial.
The 2020 OPTN policy change moved from regional to circle-based allocation, which softens but does not eliminate the truncation effect. Local geography still matters.
Educational only — clinician review pending. Not medical advice. Your transplant team has the final word.