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Community update: Policy development based on continuous distribution

Community update: Policy development based on continuous distribution

A message from Jerry McCauley, M.D., M.P.H., FACP, UNOS Board of Directors President.

Dear colleagues,

Organ allocation based on continuous distribution is now moving from concept to established policy. Thank you for all of your work thus far to inform the policy development process—your role in continually evaluating and enhancing policy is critical to the improvement and growth of the system. While much remains to be done, I am proud to say we are now in a completely new and modern era of organ allocation.

By design, the OPTN Board of Directors and committees have staggered the phases of development and implementation for the various organ systems. The recent implementation of the lung allocation policy is a huge milestone. But it is not occurring in isolation. We continue to need your expertise in developing other organ-specific policies as they move through each stage of the process.

Following are brief updates on the status of each of the continuous distribution initiatives.


The lung allocation policy based on a Composite Allocation Score (CAS) is now in effect. This is a groundbreaking development for our field. The lung policy is expected to:

  • Reduce waitlist deaths
  • Increase transplant access for the most medically urgent patients
  • Improve the efficiency of organ allocation

We will watch the policy’s performance very closely. If additional measures are needed to ensure equitable transplant access for lung candidates, our community will assess further solutions and act on them quickly. A three-month policy monitoring report will be available later this year as an initial assessment, although we know some key outcomes will take longer to study.

Kidney and pancreas

Work continues on the development of kidney and pancreas allocation based on continuous distribution. The most recent update as well as the first SRTR modeling report is available on the OPTN website. Additionally, there is a workgroup studying various operational considerations unique to kidney and pancreas transplantation and a review board for kidney and pancreas is in development. The Kidney Transplantation and Pancreas Transplantation committees will soon be requesting additional simulation analysis from the SRTR. The committees will then use these insights to develop proposals for public comment.

In response to several inquiries from living donors, UNOS released a statement assuring the community that under the new continuous distribution framework, both prior and future living donors will receive the same level of priority for a deceased donor organ as they receive in the current allocation system. You can read the full statement here.

Liver and intestines

The liver values prioritization exercise was open through March 18. Thank you to everyone who completed the exercise. We are pleased that we received feedback from more than 900 participants, which is the highest number of respondents we’ve had to any of the exercises. The Liver and Intestinal Organ Transplantation Committee will consider this feedback as it develops a future proposal.


The Heart Transplantation Committee is in the initial stages of discussion to begin work toward a heart allocation policy based on continuous distribution. The committee has been considering potential attributes for inclusion in the first iteration of a continuous distribution allocation framework and plans to consider potential ratings scores in the future. More detailed updates will come later this year.

We will carefully study the early results of each policy as it is implemented, make any needed adjustments, and use what we have learned to guide the development of other policies at earlier stages. We continue to recognize the ethical considerations of the framework, which the OPTN Ethics Committee set forth in a white paper in 2021 that was then approved by the Board of Directors.

More resource information is available on both the OPTN and UNOS websites. Please share it with your peers, your patients, and anyone who supports efforts to continue improving the system to better serve the patients who rely on it—and on us—every day.


Jerry McCauley, M.D., M.P.H., FACP

President, UNOS Board of Directors


Lung continuous distribution

New lung policy took effect March 9, 2023. Resources: UNOS Connect for professional education and the OPTN toolkit for patients and professionals.
Illustration of icons: hand icon with 3 arrows; one pointing up to lungs, one rising and pointing to right, one rising and pointing to left at balanced scale
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