OPTN/SRTR 2024 Annual Data Report: Lung

In 2024, lung transplantation in the United States reached record levels, with 3,404 total procedures (3,375 in adults and 29 in pediatric patients) reflecting continued growth in both waitlist size and transplant activity. The adult candidate population is older, more medically complex, and increasingly diverse, with 83.7% aged 50 years or older and rising proportions of Hispanic and Black candidates. Waitlist urgency and long-term posttransplant survival, as incorporated into the Composite Allocation Score (CAS), have reshaped transplant access-contributing to markedly reduced waiting times and improved transplant rates, which exceeded 350 transplants per 100 patient-years for the first time. Notably, pretransplant mortality declined for the sickest patients despite their growing representation on the national waiting list, although differences in access persist by race and ethnicity, sex, blood type, and height. Geographic distances between donor and recipient hospitals grew dramatically under the new continuous distribution allocation framework, from less than 15% to over half of lung transplants involving travel distances of 500 miles or greater. Recipient outcomes showed modest early survival improvements, with 1-year mortality at 9.4% (for transplants in 2023) and 5-year survival (for transplants in 2017-2019) of 60.1%, although older recipients fared worse. Pediatric lung transplant activity remained low, with fewer than 30 transplants in 2024, and outcomes remain variable but showed improvements in pretransplant mortality and transplant rates. Finally, donor availability expanded significantly, particularly from donors who were older and from donation after circulatory death, although nonuse rates rose in parallel, likely reflecting evolving procurement and allocation practices under regulatory requirements. These data collectively underscored the transformative impact of the CAS and the continuous distribution system, while highlighting key areas for ongoing monitoring to ensure equity, efficiency, and sustained outcome improvements in US lung transplantation.