The year 2023 marked a year of major transition for the lung transplant community in the United States, as it became the first to adopt the continuous distribution system for organ allocation. Starting on March 9, 2023, the composite allocation score (CAS) was used to rank candidates for access to a lung transplant. Shortly after the adoption of this CAS system, it was amended to better represent the biological disadvantage of candidates with blood type O for accessing a donor organ. Despite the challenges of implementing major changes to the system, the year 2023 marked many successes and milestones in US lung transplantation. A total of 3,049 adult lung transplants were performed, representing the most transplants performed in any single year. Transplant rates continued their increase over time and reached an all-time high of 307.6 transplants per 100 patient-years for adults on the waiting list. By 1 year after listing, 81.2% of adult candidates underwent a deceased donor lung transplant, with 62.6% of them having waited 3 months or less. Adult waitlist mortality rates decreased to their lowest at 13.3 deaths per 100 patient-years, meeting one of the major goals of the organ allocation systems: to decrease waitlist mortality. Survival after lung transplant remained stable over the past decade with 88.5% of adults who underwent transplant in 2022 surviving to 1 year compared with 87.2% of adults who underwent transplant in 2013.