In May 2005, a system was established to allocate deceased donor lungs to adolescents and adults in the United States based on models of waiting list mortality and one-yr transplant survival benefit. The goal of the new system is to reduce the mortality of patients awaiting lung transplant and maximize the survival benefit of lung transplantation. This article discusses the considerations given to pediatric candidates during the development of the LAS, early outcome observations with emphasis on pediatric candidates and finally, future changes and impact on pediatric lung transplantation.