<h3>Purpose</h3> Extracorporeal membrane oxygenation (ECMO) is used as a bridge for the sickest patients awaiting heart transplantation (HT). Herein, we report on six-month post-transplant survival in patients bridged with ECMO in the year before (PRE) and after (POST) the implementation of the updated UNOS Policy allocation system (October 18, 2018). <h3>Methods</h3> We identified 172 (PRE, N = 27, POST, N-145) adult patients in the UNOS registry that underwent heart transplantation from ECMO during the year before and after UNOS policy change. Baseline clinical characteristics were compared using Mann-Whitney U test and Chi-square test as appropriate. Survival analysis was performed using Kaplan-Meier analysis. Univariate and Multivariate Cox Proportional Hazards (PH) regression was performed as well. <h3>Results</h3> There was no difference in baseline clinical characteristics or hemodynamics before and after the policy change. Notably, there was a greater than 5-fold increase in ECMO utilization as a bridge to heart transplantation in the POST era. Distance from donor to recipient hospital (28 mi [7.0-271 mi] vs 261 mi [99-404 mi], p<0.001) and ischemic time (2.8 hr [2.2-3.6 hr] vs 3.5 hr [2.9-4.0 hr], p=0.007) were greater in the POST era. Six-month post-transplant survival was higher in the POST compared to PRE eras (89% vs 70%, log-rank p=0.0068). On univariate analysis the policy change was associated with decreased mortality (HR: 0.33 (0.14-0.77, p=0.010). Similarly, on multivariate analysis the policy change was associated with decreased mortality (HR: 0.26 (0.10-0.66), p=0.005). <h3>Conclusion</h3> Despite longer ischemic times and a greater distance between donor and recipient hospitals, six-month, post-transplant survival in patients bridged to heart transplant with ECMO improved after the UNOS policy change.