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Hydropower is a globally important renewable energy source with profound impacts on aquatic organisms, including direct injury and mortality to fish that move through hydropower facilities. While it is expected that the characteristics of turbine design and operation influence the type, frequency, and magnitude of injuries suffered by entrained fish, few direct comparisons exist to illustrate differences in fish survival outcomes for conventional and novel turbine designs. This study evaluated injury and mortality rates for juvenile white sturgeon (Acipenser transmontanus) passed through a model-scale turbine equipped with a runner having conventional blade profiles (thin, straight leading edges) and the same turbine equipped with a runner designed for improved fish survival (thick, slanted leading edges). In both trials, head and turbine runner rotational speeds were matched to produce five blade peripheral speeds between 15.0 and 27.6 m/s. High-speed video was captured for all turbine passage events. Fish were assessed for injuries following passage, and mortalities were assessed immediately after passage and after 48 hours. Conventional runner passage resulted in 42% to 78% survival after 48 hours, with approximately one-third of all tested fish killed by severing. Under the same test conditions, immediate and 48 h survival rates through the novel runner were 100% except at the highest speed condition (95.6% survival at 48 h). These results clearly indicate that turbine design has a profound effect on fish survival outcomes, and suggest that thoughtful redesign of hydropower equipment could significantly elevate fish survival rates.