RT Journal Article SR Electronic T1 Ethical analysis examining the prioritisation of living donor transplantation in times of healthcare rationing JF Journal of Medical Ethics JO J Med Ethics FD BMJ Publishing Group Ltd and Institute of Medical Ethics SP 389 OP 392 DO 10.1136/medethics-2021-107574 VO 49 IS 6 A1 Kulkarni, Sanjay A1 Flescher, Andrew A1 Ahmad, Mahwish A1 Bayliss, George A1 Bearl, David A1 Biondi, Lynsey A1 Davis, Earnest A1 George, Roshan A1 Gordon, Elisa A1 Lyons, Tania A1 Wightman, Aaron A1 Ladin, Keren YR 2023 UL http://jme.bmj.com/content/49/6/389.abstract 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.