*Purpose: In an emergency action on November 24, 2017 the Organ Procurement and Transplantation Network (OPTN) altered US lung allocation policy by replacing the donor service area (DSA) with a 250 nautical mile (NM) circle around the donor hospital as the first unit of allocation for deceased donor lungs.

*Methods: OPTN data on adult lung candidates and recipients was analyzed pre (11/25/2016- 8/24/2017) and post policy change (11/25/2017- 8/24/2018, 9 months). Cohorts were compared to study the differences.

*Results: There was an increase in match LAS at transplant from the pre era (N=1,806) to the post era (N=1,843) (mean pre=47.24 vs. post=49.68, p < 0.001) and increase in the distance from donor hospital to transplant center (median pre=116 NM vs. post=166 NM, p=0.005). A 57.2% decrease in within DSA transplants and an increase in regional and national transplants was seen in the post era. By OPTN region, the change in the number of transplants performed ranged from -21 to +51. A decrease was seen in the transplant rate for candidates with LAS 40-50 (RR=0.85, CI: 0.74, 0.98). Candidates with LAS 60-70 experienced a drop in waitlist mortality (RR=0.23, CI: 0.08, 0.65). Organ utilization rate did not change (pre=22.41 vs. post=22.28, p=0.851); however, there was an increase in the use of EVLP (84 lungs pre vs. 196 lungs post) during this period.

*Conclusions: Replacing DSA with a 250 NM circle in lung allocation has resulted in increased distance traveled from transplant center to donor hospital to provide transplant to sickest candidates (highest LAS). A as result, there was decrease in waitlist mortality for the sickest candidates. The OPTN Thoracic Transplantation Committee will continue to monitor impact of this policy.

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