<h3>Purpose</h3> The Organ Procurement and Transplantation Network (OPTN) US lung allocation policy was altered in 2017 by changing the first geographic unit of lung allocation from the donation service area (DSA) to a 250 nautical mile (NM) radius around the donor hospital. <h3>Methods</h3> OPTN data on lung candidates and recipients age gt; 11 was analyzed pre (11/26/2015- 11/24/2017) and post allocation policy change (11/25/2017- 11/24/2019). Cohorts were compared to study the differences. <h3>Results</h3> An increase was seen in the match lung allocation score (LAS) at transplant from pre to post era (mean pre=47.25 vs. post=49.79, p < 0.001) and a similar increase in the volume of transplants for candidates with an LAS over 50 (pre=1,260; post=1,702). The waiting list mortality and transplant rate did not change when examined by LAS and diagnosis group except for LAS group 60-70 which saw a significant increase in transplant rate (pre= 429 (95% CI: 357, 512) vs. post=642 (95%CI: 558, 734)). The distance between the donor hospital and transplant center increased (median pre=109NM vs. post=166NM, p < 0.001) and subsequent increase in ischemic time (mean pre=5.3 hrs. vs. post=5.7 hrs., p < 0.001). Despite the increase in distance and ischemic time the discard rate for non-DCD and non-perfused lungs remained stable (pre=3.6 vs. post=4.0, p=0.15). Unadjusted 6-month patient post-transplant survival is unchanged (93.5% pre vs. 93.2% post). <h3>Conclusion</h3> Under the current system, lungs are being placed to sicker candidates with similar short-term post-transplant outcomes compared to the older allocation system. The next step for the lung allocation system in the US is a move to the Continuous Distribution framework to avoid hard boundaries in geography and other clinical classifications. The OPTN Lung Transplantation Committee is using these results and additional analyses to make evidence-based decisions for allocating lungs under the new framework.