*Purpose: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted the field of transplantation across Canada. In this study, we outline the implications of COVID-19 related interruptions in kidney transplant activities to Canadian end-stage renal disease (ESRD) patients.

*Methods: We used an adapted Markov microsimulation model with a 10-year horizon and an ESRD patient perspective to study the effectiveness (patient survival in months) of living (LD) or deceased donor (DD) transplantation vs. halting transplantation for the course of the pandemic. We conducted base case, scenario, and sensitivity analyses to illustrate the impact of patient and donor characteristics as well as SARS-CoV-2 infection rates and pandemic length on the preferred strategy.

*Results: The base case analysis suggested that LD offered greater effectiveness (99.18 months, 95% CI 98.32-100.04) in comparison to delaying LD and remaining on dialysis for the duration of the pandemic (95.7 months (95% CI 94.80-96.6)). In contrast, DD offered effectiveness of 95.4 months (95% CI 94.50-96.30) in comparison to 94.3 months (95% CI 93.38-95.22) when experiencing interruptions in DD transplant activities for the duration of the pandemic. Infection incidence greater than 1.4% over 5-months, shorter periods of interruptions in transplant activities, younger candidates, delayed pre-emptive transplants and transplantation of donors with higher Kidney Donor Risk Index scores made the DD strategy comparable to delaying transplant activities.

*Conclusions: Cessation of transplant activity during the COVID-19 pandemic appears to be detrimental to long-term survival of ESRD patients, contributes to organ discard, and worsens the everlasting gap between organ supply and demand.

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