An article in Bloombergbusinessweek (september 15,2014) describes a pln to increase the zones over which livers would be allocated to assign livers to sicker patients needing liver transplants. The estimate is that it will save 554 lives over five years but increase the livers transported from 50% currently to 75%, given the need to transplant within 18 hours. But costs are expected to decrease by $246 million given that it will save sicker patients. Will liver donation rate decrease if donated livers are assigned to patients that are not local? Is it fair to permit the factor of 10 difference in liver availability based on region to protect the volume of donated livers? How should the optimal tradeoff be determined, and should it be the decision of the donor to assign the region over which recipients will be chosen?