*Purpose: The COVID-19 pandemic led to a decrease in transplantation throughout the United States. We examined the impact of the pandemic in regards to the volume of pediatric donors from which livers were successfully transplanted and donor characteristics during this time.

*Methods: The UNOS database was examined between 3/1/2019 – 8/1/2019 (non-COVID era) and 3/1/2020 – 8/1/2020 (COVID era). The numbers of potential pediatric donors and those who donated livers were determined. Donor demographic data was obtained. STATA software was used to perform statistical analysis. A p-value of <0.05 was considered to be significant.

*Results: There was a 12% decrease in referral numbers of pediatric liver donors between the non-COVID period (n=440) and the COVID period (n=389). Additionally, overall (25% vs. 27% ) and intraoperative (10% vs. 11%) discard rates were higher resulting in a 14% reduction in livers for transplant between non-COVID and COVID periods. Patterns were not uniform across the country. Region 5 had an increase in donors from the non-COVID to COVID era (6.25%), while region 10 had the greatest decrease in donors (15%). Analysis of donor data did not show differences in age (10.9 vs. 11.1 y), BMI (21.7 vs. 21.2 kg/m²), AST (94 vs. 101 U/L), ALT (107 vs. 84 U/L), whole organ use (94.7% vs. 96.7%), DCD status (7.8% vs. 7.3%), or IRD status (14.8% vs. 13.0%) between COVID and non-COVID periods. Macrosteatosis (3.7% vs. 12.6%) was lower in the COVID period although few livers underwent biopsy. Interestingly, the DRI was significantly higher in the COVID period (1.77 vs. 1.60, p = 0.001) with a greater proportion of higher risk donors (DRI>2) used during COVID (24%) compared to non-COVID (20%).

*Conclusions: During the COVID period there was a large decrease in pediatric donor referral. It appears that this promoted utilization of livers with higher overall donor risk by liver transplant centers.

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