As the COVID-19 (SARS-CoV-2) pandemic has taken hold in the United States, transplant programs have had to prepare to make critical decisions during a time of severely constrained resources. A transition must be made from the traditional “justice versus utility” approach in organ allocation to a more nuanced allocation scheme based on ethical values that drive decisions in times of absolute scarcity. The goal of this new mind-set is to help guide programs in deciding which patients to transplant, which donors to accept, how to minimize risk and how to ensure the best utilization of transplant team members.

The coronavirus disease 2019 (COVID-19) pandemic has shattered the processes meticulously developed over years by which physicians delivered quality care for patients with cirrhosis. COVID-19 has exposed deep flaws in the structural and process measures developed to follow patients, evaluate disease status and response to therapy, and screen for complications, each of which depends upon frequent physical patient-physician interaction.