Spain has been one of the countries most affected by the COVID-19 pandemic. The surge of patients overwhelmed the health system capacity, and intensive care units (ICUs) collapsed under the high demand of admissions. Although endowed with a leading transplant system, donation and transplantation rates suffered a major strike during the peak of the pandemic which led to the lowest activity for the past 2 decades. To overcome this situation, different strategies have been put in place to recover the activity while guaranteeing the safety of organ recipients, live organ donors and healthcare professionals involved in the program. Four months after the first COVID-19 cases were identified in Spain, the numbers have started to rise again, but the future of donation and transplantation in the midst of the pandemic still seems uncertain.