Many deceased organ donors are a three-hour drive from the facilities designed to help them

Organ donation is a logistics problem as much as a medical one. The window between brain death and viable organ recovery is finite, and every hour matters. Donor care units (DCUs) - specialized facilities dedicated to managing deceased donors to optimize organ quality and transplant outcomes - exist precisely to address this time pressure. They concentrate expertise, equipment, and protocols in one place.

There is broad consensus that DCUs improve outcomes. But a cohort study published in JAMA Network Open reveals a significant gap between endorsement and implementation: the geographic distribution of these units leaves a substantial proportion of deceased donors after brain death more than a three-hour drive from the nearest facility.

Adoption has been piecemeal

The study, led by Peter P. Reese of Vanderbilt University Medical Center, examined the geographic accessibility of DCUs across the United States. The central finding is that adoption has been heterogeneous - a polite way of saying that whether a deceased donor has access to a specialized care unit depends largely on where they happen to die.

Some regions have DCUs in acute care hospitals. Others do not. The result is a patchwork in which some donors can be transferred to specialized facilities quickly, while others face transport distances that may compromise organ viability or simply make transfer impractical.

Boundaries that create bottlenecks

The study identified an additional structural problem: donation service area boundaries. The U.S. organ procurement system is divided into geographic territories, each served by a single organ procurement organization. These boundaries determine which organization manages a given donor and which facilities are considered accessible.

But geography does not respect administrative lines. A donor in one service area might be physically closer to a DCU across the boundary than to any facility within their own territory. The study found that these boundaries introduce inefficiencies, effectively increasing the distance between donors and available facilities.

The authors propose two potential approaches to address the access gap. First, opening additional DCUs within acute care hospitals in underserved areas, which would reduce transport distances without requiring new standalone facilities. Second, allowing donor transport across existing service area boundaries when a DCU in an adjacent territory is significantly closer.

What the study does not tell us

The paper establishes the geographic problem but does not quantify its impact on donation outcomes. Whether the donors who face longer transport times actually experience worse organ recovery rates, lower organ quality, or fewer successful transplants is not directly addressed. The association between DCU access and outcomes has been demonstrated in other research, but this study focuses specifically on the access gap itself.

The study also does not address the financial and regulatory barriers to opening new DCUs or relaxing service area boundaries. Both solutions would require coordination among organ procurement organizations, hospitals, and federal regulators - a process that has historically moved slowly in the transplantation system.

Still, the finding that a meaningful proportion of deceased donors are more than 180 minutes from the facilities designed to serve them represents a concrete, quantifiable problem - one that suggests relatively straightforward geographic solutions could meaningfully improve system efficiency.