Expedited Lung Allocation in The Era of Continuous Distribution

Background: The frequency of use of expedited offers in lung allocation has increased. Methods: This study retrospectively analyzed lung offers accepted for transplant in the United States for the period from the introduction of continuous distribution in allocation in March 2023 to March 2024 to identify characteristics of donors, recipients, and offers associated with expedited placement. Data were obtained from the Scientific Registry of Transplant Recipients and categorized by expedited vs non-expedited offers. Results: Of the 3,136 lung organ offers transplanted, 9% (284) were expedited. Expedited offers were more likely for male donors with blood type O, while recipients were typically older, male, non-Hispanic, and diagnosed with lung condition category A. These recipients also demonstrated lower composite allocation and medical urgency scores, and were less likely to be hospitalized, ventilated, or on extracorporeal life support. Time on the waitlist and post-transplant 30-day survival rates were similar between expedited and non-expedited groups. One-year survival was higher in recipients of expedited lung placements. Expedited offers had a median sequence number at acceptance of 83.5, bypassing a median of 54.5 listed patients, and were more often placed at centers with higher offer acceptance ratios. Conclusion: Expedited placements are associated with lower-acuity recipients. Further policy reform should aim to ensure equity while optimizing organ placement and recipient outcomes.