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Coming soon: Implementation of continuous distribution of lungs

Coming soon: Implementation of continuous distribution of lungs

Updated March 1, 2023: The lung allocation system based on continuous distribution was originally scheduled to take effect on March 2, 2023. The lung continuous distribution policy is now expected to implement on March 9, 2023. This system notice has been updated to reflect the change in expected implementation date.


  • All lung and heart-lung transplant programs
  • OPTN Lung Transplantation Committee
  • OPOs (for awareness)

Updated implementation date

March 9, 2023


Effective March 9, lungs will be allocated under the approved continuous distribution allocation policy.

The current Lung Allocation Score (LAS) system, which groups candidates into classifications, will be dissolved as part of the transition to a single, unified score, the lung Composite Allocation Score (CAS), to rank candidates on the lung list.

What you need to do

Members should familiarize themselves with the new policy. A policy toolkit with education and resources for professionals and patients has been developed to help you prepare.

Understand your candidate’s new priority

    • Transplant programs should utilize the Lung CAS Report in the Data Services Portal and the national data found in the Lung CAS summary data on to understand the new priority of your candidates as we transition from LAS to lung CAS.
    • Exception requests: Following review of candidate data, if a program feels a candidate’s current lung CAS does not appropriately prioritize the candidate for transplant, they may submit an exception request. Find more information here.
    • Members can use the lung Composite Allocation (CAS) calculator to better understand the impact of various clinical characteristics on the lung CAS and estimate a candidate’s score.

Review donor acceptance criteria changes

Transplant programs should review the local donor age, height, weight, and DCD status acceptance criteria for your lung, heart and heart-lung candidates on the waiting list. These fields will be simplified to a single field for donor acceptance criteria for heart, heart-lung and lung candidate listings. Effective March 9, all matches will use the acceptance criteria you currently have specified for local donors. Find more information here.

Review data collection fields

    • Transplant programs should review the Lung Composite Allocation Score: 28 day report in WaitlistSM for their program and:
    • Update responses to the question “On high flow nasal cannula?” for candidates on supplemental oxygen at rest, with exercise, or at night. The field will be required upon implementation on March 9 and going forward.
    • Monitor candidates meeting the criteria for lung clinical values that must be updated every 28 days. A transplant hospital must update all of the following clinical values at least once in every 28 day period after the candidate meets criteria. Values out of compliance will be substituted with normal or least beneficial values in the lung CAS upon implementation on March 9 and going forward.

If your candidate has donated an organ for transplantation within the U.S. or its territories, they are eligible for additional points under lung continuous distribution allocation. Report this information to the OPTN using the form available in UNet under Resources, Forms/Tools, “Prior Living Donor Priority Request Form.”

These fields were implemented on Nov. 8, 2022, read the implementation notice for more details.

Additional details

Unacceptable antigens: Effective upon implementation, sensitized candidates will receive additional lung CAS points based on the CPRA score calculated from the unacceptable antigens entered in Waitlist. As a reminder, candidate unacceptable antigens are used as screening criteria for matches.

Education and resources

Follow the Lung Continuous Distribution playlist on UNOS Connect to receive notifications when new trainings are added. Members can access UNOS Connect via the Resources menu within UNetSM.

Overview courses for all members:

    • LUN102: Basic Principles of Lung Continuous Distribution
    • LUN103: Unacceptable Antigens and CPRA in Lung Continuous Distribution
    • LUN104: Scoring and Exceptions Under Lung Continuous Distribution
    • LUN105: Preparing for Implementation of Lung Continuous Distribution

For transplant programs:

    • SYS183 Using the Lung CAS Report
    • SYS186 UNet for Lung Continuous Distribution
    • LUN107: Continuous Distribution of Lungs for Transplant Coordinators

For OPOs:

    • LUN106: OPO Considerations for Lung Continuous Distribution

For Review Board members:

    • LUN101: Lung Review Board Member Orientation under Continuous Distribution

Upcoming webinars:

    • Feb 10: Lung continuous distribution: Exception Requests and Review Board
    • Feb. 17: Lung continuous distribution and multi-organ allocation
    • Feb: 23: Patient Webinar-Preparing for lung continuous distribution
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