Impact of continuous distribution as the allocation strategy on lung transplantation

In March 2023, the allocation strategy for lung transplantation (LT) underwent significant changes with the introduction of the new system, referred to as the continuous distribution (CD). The current paper describes the early impact of CD implementation on the mechanics of LT at a large tertiary care medical center. This was a retrospective study conducted across 9 months before (March 2022 to November 2022) and after (March 2023 to November 2023) the implementation of the CD allocation system. The number of lung donor offers increased by 59% in the post-CD period (P = .002). The median offers per waitlisted patient increased even more (P < .001), leading to a significant reduction in time to transplant (P < .001). Early clinical outcomes (median length of stay and hospital survival) were unchanged, whereas the cumulative length of index hospitalization was lower by 10% during the post-CD period. The cost/bed-day increased by 4.5% in the post-CD period, which converted to a 32% decrease in the contribution margin per transplant. In conclusion, the implementation of CD was associated with improved access to donor lungs, leading to favorable trends in the time to transplant while maintaining posttransplant outcomes. The CD was associated with a significant jump in the cost of LT.