The United States Kidney Allocation System (KAS) consists of 3 parts: eligibility (the minimal medical criterion for a patient to be eligible for a transplant), allocation (the rules by which eligible patients on the waitlist are prioritized for deceased donor kidneys), and distribution (the geographic units over which organs are shared). Of these, distribution has been identified as one of the sources of geographic disparity in access to successful kidney transplantation.1 Since then, efforts to remove arbitrary geographic boundaries to organ distribution have been ongoing.