*Purpose: The opioid epidemic afflicting our nation has led to a surge in the number of adult deceased donors from drug overdose. We hypothesized that these donors are being underutilized in the pediatric population despite being ideal candidates for splitting.

*Methods: The UNOS database was retrospectively reviewed for all primary liver transplants performed between March 2002 and December 2017. Donor criteria for splitting was defined as age < 40 years, BMI < 28 kg/m2, ALT/AST < 3 times upper limit of normal, and no inotropic support.

*Results: While the number of donors from drug overdose used for liver transplants has increased substantially for adult recipients, it has remained relatively stable among pediatric recipients (Figure 1). 886 of the 5,022 deceased donors from drug overdose met criteria for splitting. Of these, 30 were used as a segmental graft and an additional 70 were used as a segmental graft outside the defined criteria. 1,155 children died or became too sick to transplant while on the waitlist during this time period. Survival of grafts from drug overdose was equivalent to those from other causes in children and actually significantly better in adults (Figure 2).

*Conclusions: While the opioid epidemic has led to a surge in adult liver transplants, these donors are underutilized in the pediatric population. Although there may be hesitation to allocate donors who died from drug overdose to children, outcomes with these grafts are excellent. We anticipate that the recently approved Region 8 split variance demonstration project will expand the number of split grafts, including those from drug overdose donors, thereby addressing the organ shortages in both the pediatric and adult populations.

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