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Transplant programs are being scaled back as healthcare systems worldwide respond to COVID-19. Most centers are now taking only superurgent and urgent cases, if at all. Management of donor organs is also affected. Contingency protocols may prioritize distance over equitable sharing principles. Live and deceased donation is either being selectively paused or operating under stringent criteria based on local capacity. This will inevitably lead to variable patient experience.

Healthcare rationing is understandably being driven by concerns of limited workforce, patient safety (intensive care unit capacity, ability to segregate critical care), and paucity of data on the disease in transplant recipients. Although pragmatic, the disproportionate resource allocation to COVID-19 will have unintended consequences for those already carrying the burden of health inequality. While these effects may be unavoidable, decision …