Purpose The heart allocation system allocates hearts based on geographic distance between donor and transplant centers, blood type and severity of illness. The Donor Service Area (DSA) designation and fixed distance radii may be abolished if a continuous allocation is implemented. This study sought to assess whether donor heart allocation within the DSA is associated with a survival benefit. Methods Heart transplant recipients between 2010 and 2018 were identified in the Organ Procurement and Transplant Network (OPTN). Following adjustment for the expected post-transplant graft survival, a Bayesian logistic regression model was used to assess the effect of DSA versus extra-DSA allocation of donor hearts. The primary outcome was one-year graft survival adjusted for risk of graft failure using the Scientific Registry of Transplant Recipient's (SRTR) January 2019 adjustment model. Results Locally allocated donor hearts were more likely younger and gender matched and had lower prevalence of donor diabetes and smoking when compared to those imported from another DSA (Table 1). The proportion of locally shared organs between regions varied significantly (p<0.0001). The median ischemic time was 2.68 (IQR 2.10-3.33) hours for local hearts and 3.72 (IQR 3.30-4.23) hours for imported hearts with a significant difference between the two groups (p< 0.0001, Figure 1). DSA allocation increased by 4.6% each year (ptrend= <0.0001) and had no large effect on model-adjusted one-year graft failure (OR 0.999, p = 0.986). Conclusion Following adjustment for recipient and donor factors, we found that allocation of organs within the DSA did not reduce one-year graft failure rates.