PT - JOURNAL ARTICLE AU - Sanjay Kulkarni AU - Andrew Flescher AU - Mahwish Ahmad AU - George Bayliss AU - David Bearl AU - Lynsey Biondi AU - Earnest Davis AU - Roshan George AU - Elisa Gordon AU - Tania Lyons AU - Aaron Wightman AU - Keren Ladin TI - Ethical analysis examining the prioritisation of living donor transplantation in times of healthcare rationing AID - 10.1136/medethics-2021-107574 DP - 2022 Jan 04 TA - Journal of Medical Ethics PG - medethics-2021-107574 4099 - http://jme.bmj.com/content/early/2022/01/12/medethics-2021-107574.short 4100 - http://jme.bmj.com/content/early/2022/01/12/medethics-2021-107574.full AB - The transplant community has faced unprecedented challenges balancing risks of performing living donor transplants during the COVID-19 pandemic with harms of temporarily suspending these procedures. Decisions regarding postponement of living donation stem from its designation as an elective procedure, this despite that the Centers for Medicare and Medicaid Services categorise transplant procedures as tier 3b (high medical urgency—do not postpone). In times of severe resource constraints, health systems may be operating under crisis or contingency standards of care. In this manuscript, the United Network for Organ Sharing Ethics Workgroup explores prioritisation of living donation where health systems operate under contingency standards of care and provide a framework with recommendations to the transplant community on how to approach living donation in these circumstances.To guide the transplant community in future decisions, this analysis suggests that: (1) living donor transplants represent an important option for individuals with end-stage liver and kidney disease and should not be suspended uniformly under contingency standards, (2) exposure risk to SARS-CoV-2 should be balanced with other risks, such as exposure risks at dialysis centres. Because many of these risks are not quantifiable, donors and recipients should be included in discussions on what constitutes acceptable risk, (3) transplant hospitals should strive to maintain a critical transplant workforce and avoid diverting expertise, which could negatively impact patient preparedness for transplant, (4) transplant hospitals should consider implementing protocols to ensure early detection of SARS-CoV-2 infections and discuss these measures with donors and recipients in a process of shared decision-making.All data relevant to the study are included in the article.