This study analyzed 32,036 adult heart transplant recipients from 2010 to 2023 to assess long-distance donor (LDD) utilization after the 2018 allocation policy change. LDD use increased from 5.5 percent to 14 percent, with mean donor distance rising from 171 to 288 miles. Risk-adjusted survival was significantly better with LDD at 30-day, 1-year, and 5-year intervals. Distance correlated weakly with ischemia time. Despite increased cold ischemia time (from 3.20 to 3.60 hours), outcomes improved with LDD, suggesting that distance alone does not predict ischemia time or survival.