*Purpose: To describe the impact of the lung allocation change on a single organ procurement organization (OPO). The allocation change took place on 11/24/2017 and instituted a concentric circle approach in thoracic allocation policy where 250 nautical miles surrounding the donor location would receive initial offers rather than the more arbitrary Donor Service Area (DSA). The Organ Procurement and Transplant Network’s (OPTN’s) Final Rule noted the goal of distributing organs over a broader geographic area in order to decrease medical urgency.

*Methods: A retrospective review of all deceased adult recipient heart transplants recovered from the OPO service area from 05/24/19-05/24/19. Variables of interest included: total number of lungs transplanted, lung allocation score (LAS) of recipients, distance to ship, overall observed vs. expected lung yield (O:E), and rate of lungs accepted by the local center.

*Results: In the pre-allocation cohort (PRE), 46 lung donors were recovered by the OPO and 82 lungs were transplanted. In the post allocation cohort (POST), 48 lung donors were recovered by the OPO and 88 lungs were transplanted to recipients in the United States. Notable were five additional donors and ten additional lungs transplanted internationally from POST. These lungs were not included in the analysis. The largest impact of the allocation change for this OPO has been the increase in lungs transplanted outside the DSA but remaining in the region: 19.5% of lungs were transplanted in the DSA in PRE, compared to 6.8% in POST. The average LAS of recipients has decreased. In PRE 24% of recipients had LAS scores >60, in POST 9.3% of recipients have LAS >60.

*Conclusions: The impact of the allocation change on our OPO has been the increase in organs leaving our DSA but remaining in the region. In addition, this OPO’s experience shows fewer high LAS recipients being transplanted in the POST cohort, implying recipients are being transplanted prior to reaching high acuity. Further studies with these variables in a regional and national cohort may yield different outcomes. The cost of broader sharing requires further study.

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