To the Editor: The COVID-19 pandemic has disrupted many aspects of vital medical care, including transplantation—with another surge in progress. In March 2020, faced with potential shortages of ventilators, dialysis machines, and personal protective equipment, hospital systems drastically scaled back or halted vital activities—including new transplants—in effort to mobilize resources for anticipated or realized COVID-19 admissions. As for all solid organ transplant, 1, 2 pancreas transplant has been impacted by the pandemic, but has received less attention. As of October 26, 2020, only 781 total pancreas transplants had been performed in the United States, 2 which is a drop of~ 10% from the corresponding date last year (Figure 1A). Based on historical volume, we would have projected 1038 total pancreas transplants in the United States during 2020, including simultaneous pancreas-kidney transplant (SPKT), pancreas after kidney transplant (PAKT), and pancreas transplant alone (PTA). While pancreas transplant activity has increased since June 2020, we estimate the actual number of pancreas transplants may reach about 900. Based on SRTR data (Figure 1B), pancreas transplant volume changes did not seem to be related to historic pancreas transplant center volume, 3 suggesting that local pandemic conditions may be the dominant factor.

Transplants occur in the context of the larger healthcare system that has additional global constraints. Ethical and logistical balancing of transplant activity during the pandemic must take those constraints into account, 4-6 many of which are beyond the influence of the transplant center. Regional hospitals may not have intensive care resources to maintain potential deceased donors. Transplant providers may be reassigned to pandemic-related