The COVID-19 pandemic has uniquely affected the United States. We hypothesize that transplantation would be uniquely affected.

In this population-based cohort study, adult transplantation data were examined as time series data. Autoregressive-integrated-moving-average models of transplantation rates were developed using data from 1990 to 2019 to forecast the 2020 expected rates in a theoretical scenario if the pandemic did not occur to generate observed-to-expected (O/E) ratios.

32,594 transplants were expected in 2020, and only 30,566 occurred (O/E 0.94, CI 0.88-0.99). 58,152 waitlist registrations were expected and 50,241 occurred (O/E 0.86, CI 0.80-0.94). O/E ratios of transplants were kidney 0.92 (0.86-0.98), liver 0.96 (0.89-1.04), heart 1.05 (0.91-1.23), and lung 0.92 (0.82-1.04). O/E ratios of registrations were kidney 0.84 (0.77-0.93), liver 0.95 (0.86-1.06), heart 0.99 (0.85-1.18), and lung 0.80 (0.70-0.94).

The COVID-19 pandemic was associated with a significant deficit in transplantation. The impact was strongest in kidney transplantation and waitlist registration.