*Purpose: Pediatric liver transplant centers tend to send their own procurement team for organ assessment and recovery. TXSB organ procurement organization (OPO) hired a full-time donor surgeon in 2014 and began sending an additional surgeon to pediatric procurements. The aim of our study was to investigate the impact of the OPO surgeon on rates and patterns of pediatric liver allograft utilization.

*Methods: OPO data was obtained for all pediatric procurements that were performed over a 7-year time period between 2010-2017. The OPO surgeon started procuring organs for the OPO in April 2014. All procurements were included for analysis, and stratified based on the presence of the OPO surgeon. Analysis was performed to see if presence of a donor surgeon impacted the utilization of pediatric livers. Donor and recipient demographic data were examined. A p-value of <0.05 was considered significant.

*Results: There were a total of 361 pediatric procurements over this time period. Of those, 93 procurements included a donor surgeon, and 268 did not have a donor surgeon. In procurements with an OPO surgeon, donors were younger (9.1 vs. 11.5 years, p < 0.05), had higher terminal aspartate transaminase (126 vs. 91 units/L, p < 0.05), longer distance to travel to the recipient center (301 vs. 215 miles, p < 0.05), but a shorter cold ischemic time (6.4 vs. 6.9 hours, p < 0.05). Recipients of pediatric livers were significantly younger (35 vs. 24 years, p < 0.05) with a trend towards a lower MELD/PELD score (16 vs. 19, p = 0.059), and less likely to have a diagnosis of hepatocellular carcinoma (12% vs. 34%, p < 0.05) when the OPO surgeon was part of the donor process. In terms of organ share type, there were significantly more nationally shared livers with an OPO surgeon present (28% vs. 9%, p < 0.05). No significant difference in discard rates from the procurement with or without OPO surgeon (7% vs. 5%, p = NS) was noted. The OPO surgeon lead to an increased percentage of pediatric livers being transplanted into a pediatric recipients (38% vs. 59%, p < 0.05) through increased regional and national sharing.

*Conclusions: Presence of an OPO surgeon has altered organ utilization and leads to increased transplantation of pediatric livers in pediatric recipients and expands the geographical share of pediatric livers. The OPO surgeon appears to be a beneficial factor for pediatric patients awaiting liver transplantation.

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