The number of highly sensitized patients in need of a multiorgan transplant is increasing. Criteria informing their transplant candidacy, approaches to management on the waitlist, and protocols related to alloantibody monitoring vary widely. We convened a consensus conference to discuss these different practices in the United States and the United Kingdom and to review the contemporary outcomes of these challenging cases. A detailed analysis of the data regarding the liver allografts' immunoprotective effect on simultaneously transplanted other organs was also completed, and the prospect of the use of liver allografts primarily to facilitate transplantation of highly sensitized patients in need of other organs was discussed. The ethical and allocation-related issues about such prospect were debated with a goal to standardize the approach and provide an evidence-based pathway for pre-, peri-, and post-transplantation management for the highly sensitized multiorgan transplantation candidate.