*Purpose: COVID-19 causes more severe complications in older patients and disproportionately leads to poor outcomes in racial minorities. High offer acceptance rates indicate better access to transplant. Because access to transplant is critical for patients with end-stage organ failure, we investigated the effect of COVID-19 on offer acceptance rates by candidate age and race before and after the national emergency declaration on March 13, 2020 for kidney, liver, lung, and heart transplant.

*Methods: We used match run data from March 13, 2019 to August 31, 2020 and included offers that resulted in at least 1 acceptance. Logistic regressions estimated differences in offer acceptance by candidate age and race before and after COVID-19 (i.e., the effects for age and race interacted with an indicator of donors recovered after March 12, 2020), and the regressions adjusted for the location of the offer in the match run and other candidate and donor characteristics.

*Results: Overall, offer acceptance rates were lower for kidney, liver, and heart transplant after COVID-19 than before (Table 1). Differences in kidney offer acceptance across candidate age had a dose-response relationship: offer acceptance rates were higher in younger kidney candidates before and after COVID-19 than in older candidates. Offer acceptance rates for Black and Asian candidates decreased more before and after COVID-19 than for White candidates (Table 1). Offer acceptance rates for liver, lung, and heart candidates did not notably differ before and after COVID-19 by candidate age and race.

*Conclusions: Thus, COVID-19 inequitably affected kidney offer acceptance rates across candidate age and racial groups.

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