Lung transplantation outcome changes from the new US lung allocation system

In 2005, the US lung transplant community made important changes to its approach to organ allocation. Before May 2005, priority was determined by time on the waiting list. Since May 2005, priority has been assigned based on the Lung Allocation Score (LAS). A composite of estimated risk and survival benefit, the LAS provides a more objective basis for lung allocation. The LAS system has led to reduced wait-list mortality and shorter wait times. However, transplant mortality seems to be unchanged. The effect of the LAS on overall efficiency is not clear. With regard to equity, the conclusions are mixed, and an unintended outcome of the LAS may be the trend toward transplanting sicker patients who are less likely to survive. The LAS was intended to be dynamic, and further research should focus on the value of LAS with regard to predicting survival and prioritizing resource allocation.