Skip to main content

OPTN regional review

OPTN Plan to Review and Analyze the Regional Process

The purpose of this project was to optimize Organ Procurement and Transplantation Network (OPTN) governance and operational effectiveness by evaluating the roles of Regions in the OPTN structure.

Through a transparent and objective process, the OPTN engaged with a third party vendor, EY, to review and analyze the OPTN regional structure and processes. EY evaluated several factors, including OPTN community input, to develop a series of recommendations for the OPTN Board of Directors. Any proposed changes that require Bylaw or policy changes will be released for public comment prior to Board action. The Board of Directors will be responsible for approving any changes resulting from this project.

The project addressed various goals and questions around the OPTN Regions including, but not limited to:

  • The purpose of OPTN Regions – to the OPTN, members, and patients
  • The basis for geographic regions in the governance and operation of OPTN in an era of broader geographic sharing
  • How OPTN Regions are used for representation of OPTN members
  • The current approach to structuring OPTN committees and the Board of Directors with regional representatives
  • The metrics needed to track and evaluate effectiveness of the OPTN, and how regions contribute to them
  • Whether the current configuration of regions is optimized
  • Other configurations that could be considered and what factors would influence a reconfiguration

We encourage you to regularly visit this website to receive project updates and provide your feedback.

View community feedback on the proposed redesigned the map of OPTN Regions.

Read input received

About OPTN Regions:

The OPTN Regions were created from groupings of Donation Service Areas (DSAs) to help manage the national organ transplant network.

These regional boundaries reflected patient referral and organ sharing patterns when they were created in 1986. Since that time, some regional boundaries have been adjusted to account for new relationships between Organ Procurement Organizations (OPOs) and transplant centers or to balance populations among regions. Regions are not uniform in size or population.

There are currently eleven (11) OPTN Regions:

Regions map
Regions map Region 1 Region 2 Region 3 Region 4 Region 5 Region 6 Region 7 Region 8 Region 9 Region 10 Region 11

  • Region 1: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Eastern Vermont
  • Region 2: Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania, West Virginia, Northern Virginia
  • Region 3: Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Puerto Rico
  • Region 4: Oklahoma, Texas
  • Region 5: Arizona, California, Nevada, New Mexico, Utah
  • Region 6: Alaska, Hawaii, Idaho, Montana, Oregon, Washington
  • Region 7: Illinois, Minnesota, North Dakota, South Dakota, Wisconsin
  • Region 8: Colorado, Iowa, Kansas, Missouri, Nebraska, Wyoming
  • Region 9: New York, Western Vermont
  • Region 10: Indiana, Michigan, Ohio
  • Region 11: Kentucky, North Carolina, South Carolina, Tennessee, Virginia

For more information about Regions, please visit the OPTN Regions webpage at:

The primary functions of the OPTN Regions are:


  • Electing Regional Councillors who represent and convene their constituents at Regional meetings, as well as serve on the OPTN Board of Directors
  • Recommending Regional representatives on OPTN Committees
  • Staffing Regional heart review boards

Communication and Feedback

  • Hosting biannual member meetings in each Region to express sentiment on policy proposals and conduct other OPTN activities as a Region


  • Discussing shared operations and effective practice

Data Analysis

  • Describing geographic differences in transplant data and demographics at the Regional level

The OPTN, the donation and transplant community, and organ allocation policies have all evolved and matured significantly since the OPTN Regions were created. This project will evaluate the structure, processes, performance, and effectiveness of Regions, considering the current and future needs of the nation’s donation and transplant community.

Project Plan

This project was designed to answer fundamental questions about the OPTN Regions, and what their purpose and goals have been in the past and should be in the future. Some of the questions considered during the work included:

  1. What are the OPTN Regions expected to accomplish - for the OPTN, for members, and for patients?
  2. What is the basis for geographic regions in the governance of OPTN in an era of broader geographic sharing?
  3. Does the current OPTN Regions approach work? If so, how? In what way do the regions “work” for the OPTN, for the members in the region, and for patients in the region? What about other stakeholders? And by what objective metrics do they and should they work?
  4. Is the current configuration of regions optimal? If so, how? In what ways are they “optimal”? And by what objective metrics should the configuration be evaluated?
  5. What other regional configurations might be considered? How many regions should there be? What basis (or bases) might be considered for reconfiguration? (For example: population density patterns, End Stage Organ Disease patterns, number/distribution of organ-specific transplant centers, specialist-tertiary referral patterns, OPO/population geographic distribution, specific geographic features (mountains, water bodies), etc.).

Community feedback about how Regions serve to organize various OPTN functions was collected to help inform the project. Early feedback was used to inform development of the Request for Proposal (RFP) that announced the project and solicited potential vendors. The selected vendor, EY, reviewed this input and developed additional strategies to collect input from the community about OPTN Regions.

EY has proven experience in systems and operations design to perform the work needed to answer the above questions, and ultimately deliver informed recommendations to the OPTN Board of Directors.

EY was chosen using extensive selection criteria, including but not limited to:

  • Experience in organizational structure design and governance
  • Expertise in management consulting
  • Expertise in operations and systems design
  • Previous client satisfaction

The scope of work of EY included, but was not limited to, the following requirements:

  • Assemble feedback from OPTN members and volunteers about the regional structure
  • Evaluate current Regional structure and process in supporting policy development consistent with the OPTN Final Rule
  • Develop recommendations for changes to the regional structure that could result in more effective OPTN governance
  • Develop a risk register and risk mitigation strategy for each recommendation
  • Deliver informed recommendations to the OPTN Board of Directors
  • Engage and review process requirements with HRSA throughout the evaluation process

The result of this project can show a very similar or very different OPTN Regional structure. That is part of what makes the work exciting, and community feedback important.

Project Roadmap

Activity Timing
Request for community input Summer
Issue RFP for external vendor to conduct the project Fall
Select external vendor to lead project Winter

Activity Timing
Vendor will review community input and connect with the community
Vendor will study OPTN system, other national governance systems, and prepare recommendations for Board of Directors review
Winter & Spring
OPTN Board of Directors receives recommendations and evaluates options Summer
Request for feedback to be issued for public comment after review by the Board of Directors Summer & Fall
Board of Directors considers recommendations from public comment and prepares concept paper Winter

Activity Timing
Proposed changes released as concept paper January
Board of Directors approves final changes June
Implementation of Board-approved recommendations

Provide feedback

The first input opportunity closed Oct. 1, 2020. The input collected was informational and was provided to EY.

Summer 2020, community input summary report

The second input opportunity closed September 30, 2021. The input collected was provided to EY, who prepared their final report for the OPTN Board of Directors.

Summer 2021 community feedback

The OPTN Executive Committee has developed a concept paper on redesigning the map of OPTN Regions to accompany the final report provided by EY.

Read the concept paper and provide your feedback

If you have any questions, please email