The Cleveland Clinic and Case Western observational analysis of Scientific Registry of Transplant Recipients data (n=3,917 candidates across 61 centers) documents persistent regional shortfalls in distance-adjusted donor availability under the Composite Allocation Score, with western centers facing roughly 30 percent lower effective supply than Midwest counterparts. This registry-based study, not an RCT, carries inherent selection and reporting biases yet aligns with prior SRTR-linked work showing allocation reforms rarely erase structural geography effects. A 2023 American Journal of Transplantation cohort study (n>12,000) similarly found rural and western candidates experienced delayed offers even after LAS-to-CAS transition, while a 2024 Health Affairs analysis of organ procurement organization performance highlighted how donor-hospital density clusters in the South and Midwest amplify access for some populations and penalize others. The MedicalXpress coverage understates how the modeled proximity weighting further deprioritizes blood-type-O and highly sensitized patients, groups already overrepresented in minority and low-income cohorts. These patterns mirror documented kidney and liver allocation disparities, where travel burden and OPO boundaries compound social determinants often omitted from transplant journalism. Policy emphasis on efficiency therefore risks entrenching the very inequities CAS was intended to mitigate.