Lung CAS summary data updated

Updated: Mar. 24, 2025

Below is information for lung transplant program physicians, surgeons, transplant coordinators, program directors and data coordinators on the distribution of scores for all lung candidates registered in the U.S. It is intended as a point-in-time reference to help transplant programs understand how their candidates’ scores compare to the national distribution of components of the lung Composite Allocation Score (lung CAS). Members can also use this information as a guide when submitting CAS exception requests for lung candidates. See the Lung Review Board Operational Guidelines and Clinical Guidance for more information on submitting exception requests. The guidance includes specific recommendations for lung transplant candidates diagnosed with pulmonary hypertension (PH). Such candidates who meet the following criteria may qualify for an increase in their Waitlist Survival and/or Post-Transplant Outcomes Scores:

  1. Patient is deteriorating on optimal therapy, and
  2. Patient has a right atrial pressure greater than 15 mm Hg or a cardiac index less than 1.8 L/min/m2

To request an increase in a PH candidate’s scores, transplant programs must submit an exception request to the Review Board; this request should include sufficient clinical detail to support that the patient meets the above criteria. If the transplant program believes that its patient has similar waiting list mortality and potential transplant benefit as a PH patient meeting the criteria listed above, then it should provide a detailed narrative on that assertion, referencing literature supporting the request for a higher score. Transplant programs may wish to submit to the Review Board exception requests for the candidate’s Waitlist Survival Score and Post-Transplant Outcomes Score to be at the national 90th percentile for each goal (see tables below). The distribution of Medical Urgency points, Post-transplant Outcomes points, Biological Disadvantages points, CAS subscores for all active registrations waiting for lung transplants as of the date at the top of the page, are listed below.

Please note: When submitting an exception request for one of the attributes, when prompted to enter the requested percentage of goal:

  • You first need to identify the percentile column that you are requesting in the corresponding table
  • Then enter the value in the Percentage of Goal row that corresponds with that percentile
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Summary of Medical Urgency Goal Points and Percentage of Goal

Medical Urgency Number Waiting 25th percentile Median 75th percentile 90th percentile 95th percentile 99th percentile
Number of Points 948 0.1275 0.3275 0.6800 1.5200 3.1925 13.1300
Percentage of Goal 948 0.5100% 1.3100% 2.7200% 6.0800% 12.7700% 52.5200%

Summary of Post-Transplant Outcomes Goal Points and Percentage of Goal

Post-Transplant Outcomes Number Waiting 25th percentile Median 75th percentile 90th percentile 95th percentile 99th percentile
Number of Points 948 18.5525 19.4350 20.1400 20.7275 21.0150 21.6600
Percentage of Goal 948 74.2100% 77.7400% 80.5600% 82.9100% 84.0600% 86.6400%

Summary of Biological Disadvantages Goal Points and Percentage of Goal

Biological Disadvantages Blood Type Number Waiting 25th percentile Median 75th percentile 90th percentile 95th percentile 99th percentile
Number of Points All Candidates 948 1.3535 5.0330 5.1740 5.5490 6.2335 9.4930
Percentage of Goal All Candidates 948 9.0233% 33.5533% 34.4933% 36.9933% 41.5567% 63.2867%
Number of Points O 599 5.0335 5.0815 5.2935 5.9510 6.7910 9.8880
Percentage of Goal O 599 33.5567% 33.8767% 35.2900% 39.6733% 45.2733% 65.9200%
Number of Points A 246 0.3362 0.3837 0.6117 1.0207 2.0122 4.9057
Percentage of Goal A 246 2.2413% 2.5580% 4.0780% 6.8047% 13.4147% 32.7047%
Number of Points B 89 2.2717 2.3487 2.7372 4.3482 6.9667 7.0557
Percentage of Goal B 89 15.1447% 15.6580% 18.2480% 28.9880% 46.4447% 47.0380%
Number of Points AB 14 0.0335 0.2705 0.4890 1.3535 1.3535 5.1595
Percentage of Goal AB 14 0.2233% 1.8033% 3.2600% 9.0233% 9.0233% 34.3967%

Summary of CAS Subscore (Note: does not include points for efficiency)

Blood Type Number Waiting 25th percentile Median 75th percentile 90th percentile 95th percentile 99th percentile
All Candidates 948 21.4332 24.3734 25.7295 27.1455 29.9780 44.8891
O 599 24.3275 25.2515 26.1835 27.8770 30.2125 44.5405
A 246 19.5977 20.5157 21.3392 23.0852 24.6142 42.9354
B 89 21.5867 22.5192 23.2917 25.5777 27.6307 46.0409
AB 14 19.9170 20.7190 22.7410 28.6630 28.6630 38.0860

a Does not include points for efficiency.

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