Lung Continuous Distribution Policy

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• Background
• Policy
• Post-implementation monitoring
• Resources for professionals & patients

Background

In December 2021, the OPTN Board of Directors approved a policy to fundamentally change the process for matching lung donors and recipients. The new policy took effect on March 9, 2023, creating a single, composite allocation score, specific to each match from a lung donor. It will replace a series of matching categories historically used to assess patients’ transplant priority.

The new policy is based on a concept known as continuous distribution. Each lung transplant candidate will receive a composite allocation score for each organ offer. This score combines weighted priority for a number of attributes that reflect the candidate’s need for a transplant and how well the candidate matches the organ donor.

On Sept. 27, 2023, additional changes took effect related to how the OPTN lung policy accounts for blood type. Read the policy notice for more details (PDF - 566 KB).

Find more information on lung continuous distribution.

Policy

Summary of policy changes

• The new policy will produce a Composite Allocation Score (CAS). This score has point values that represent each of the attributes used to match organ offers with transplant candidates. The people who have the highest number of points for that donor will be the first to get organ offers. Points are awarded based on the following attributes:
  • How urgently the candidate needs a transplant
  • How likely the person is to do well once transplanted
  • Whether the patient has any biological issues that would make him or her harder to match with a donor (for example, blood type incompatible with many donors, immune system sensitization and/or being much taller or shorter than most donors)
  • Whether the candidate is younger than age 18
  • Whether the person has been a prior living organ donor
  • How efficient it is to transport the lung(s) from donor hospital to transplant hospital (for example, ease of scheduling ground transport or flights)
  • The distance between donor hospital and transplant hospital
• The CAS will extend to decimal point values, meaning there should not be many instances where two or more candidates will have the exact same score. But if they do have a tie score for a given donor offer, the person who has waited longer for a transplant would receive an organ offer before any others who have not waited as long.

Policy documents

Establish continuous distribution of lungs

• Read the policy proposal (PDF - 3 MB)
• Read the Board briefing paper (PDF - 2 MB)
• Read the policy notice (PDF - 1 MB)
• Read public comment

Modify lung allocation by blood type

• Read the policy proposal (PDF - 1 MB)
• Read the Board briefing paper (PDF - 1 MB)
• Read public comment
• Read the policy notice (PDF - 566 KB)

Post-implementation monitoring

OPTN evaluation plan (PDF - 808 KB)

18-month monitoring report: 18-month monitoring report available for lung continuous distribution policy

• Full report (PDF - 3 MB) (PDF 12/10/2024)

One-year monitoring report: Lung transplant rate increases by 16 percent one year after continuous distribution policy is implemented

• Full report (PDF - 1 MB) (PDF 5/9/2024)

Three-month monitoring report (Modify Lung Allocation by Blood type Policy (PDF - 566 KB), effective 9/27/23): Lung transplants for blood type O increase after modified blood type rating scale

• Full report (PDF - 479 KB) (PDF 2/8/2024)

Six-month monitoring report: Lung transplants continue to increase six months post-implementation of new lung policy

• Full report (PDF - 1 MB) (PDF 10/27/2023)

Three-month monitoring report: Early lung monitoring report shows increase in transplants following implementation of lung continuous distribution

• Full report (PDF - 2 MB) (PDF 7/13/2023)