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Implementation notice: Continuous distribution of lungs

Implementation notice: Continuous distribution of lungs


  • All lung and heart-lung transplant programs
  • OPTN Lung Transplantation Committee
  • All OPTN representatives and alternative representatives
  • All OPOs

Implementation date

March 9, 2023


Effective today (March 9), lungs are now allocated under the approved continuous distribution allocation policy. The previous Lung Allocation Score (LAS) system, which grouped candidates into classifications, has been dissolved as part of the transition to the current single, unified score known as the lung Composite Allocation Score (CAS), to rank candidates on the lung list.

What you need to do

For match runs in process

Any organ offers that precede the time of implementation must continue according to the sequence as identified on the original match run, even if the offer process continues after the implementation of the new allocation system.

Understand your candidate’s new priority

  • Transplant programs can reference the Lung CAS summary data on as point-in-time reference to understand how their candidates’ scores compare to the national distribution of components of the 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 in WaitlistSM.
  • 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

Effective today (March 9), the local donor age, weight, and DCD status acceptance criteria fields have been simplified as a single field for donor acceptance criteria for heart, heart-lung and lung candidate listings. All current matches use the acceptance criteria you had specified for local donors under the previous system. Transplant programs should review this field for their candidates on the waiting list. Read the implementation notice for more details.

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 is required effective today, (March 9) .
  • Monitor candidates meeting the criteria for lung clinical values that must be updated every 28 days. A transplant hospital must update the supplemental oxygen and assisted ventilation at least once in every 28 day period for each candidate meeting criteria. Values that are missing or expired substituted with policy default values, which may include least beneficial values, to calculate the candidate’s score.

If your candidate has donated an organ for transplantation within the U.S. or its territories, they are eligible for additional points. 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: Sensitized candidates 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

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

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:

  • Basic Principles of Lung Continuous Distribution
  • Unacceptable Antigens and CPRA in Lung Continuous Distribution
  • Scoring and Exceptions Under Lung Continuous Distribution

For transplant programs:

  • UNet for Lung Continuous Distribution

For OPOs:

  • OPO Considerations for Lung Continuous Distribution

For Review Board members:

  • Lung Review Board Member Orientation under Continuous Distribution

Patient education available in the toolkit under the patient resources section:

  • Patient FAQs
  • Patient webinar recording with Spanish and English closed captions
  • Lung CAS animated explainer video
  • Find printed patient brochures in the UNOS store
  • Additional education and resources coming soon


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