The imbalance between supply and demand of organs for transplant will not be fully solved by changes to the allocation system. Improved organ donation and utilization must be accomplished through critical reassessment of organ procurement organization (OPO) performance as a partnership between transplant centers, OPOs, and community hospitals. The continued discussion on changes to the organ distribution system should be based on patient-centeredness, enhanced transparency, improved models, and metrics. Focusing too heavily on geography without consideration for the other factors at play risks oversimplification of this complex issue.