In an unprecedented legal ruling in June 2013, a US federal district court judge decided that the existing policy for donor lung allocation be vacated to save the life of a ten-year-old girl dying from cystic fibrosis. This case has fueled much controversy in the United States among policy makers, ethicists, and physicians who treat other patients awaiting transplant. This article examines the creation of the current US lung allocation policy and its impact on outcomes and analyzes the multidimensionality of the ruling. After analyzing the current policy and investigating alternatives for donor pool expansion, the article concludes by articulating options that may mitigate the need for current policy revision.

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