Background: While living liver donation (LLD) has successfully mitigated shortages in several other countries, the U.S. LLD rates have stagnated at approximately 5% since the 1980s. White individuals represent the majority of U.S. LLDs, yet there is limited understanding of racial variations. Furthermore, despite references in the current literature to two historical events in LLD history—the highly publicized donor death in 2002 and the 2020 COVID-19 pandemic—the long-term impacts of these events on LLD remain understudied.

Aims: Two aims of the study are (1) To explore and describe LLD’s characteristics in the U.S. by race; and (2) To examine the 2002 donor’s death in New York and the 2020 COVID-19 pandemic on the U.S. LLD trend.
Methods: Guided by the Health Belief Model as a theoretical framework, secondary data analysis of the Organ Procurement and Transplantation Network (OPTN) data was conducted. For Aim 1, descriptive statistics, chi-squared tests, independent ANOVA, Fisher’s exact test, and Z test were used to compare LLD’s characteristics by race. For Aim 2, Auto-Regressive Integrated Moving Average (ARIMA) modeling was used to analyze annual and quarterly LLD trends and assess the impact of the two events.

Results: Hispanic LLDs had the lowest proportions of full-time income, insurance coverage, and U.S. citizenship at the time of donation. Compared to White donors, most racial minority LLDs were younger and more likely to donate to blood-related recipients (p <0.05). Regarding the impact of two historic events, the 2002 donor’s death had a significant impact on the U.S. LLD trend (p = 0.004), with no return to pre-2002 donation levels. In contrast, the COVID-19 pandemic disrupted LLD in the second quarter (p = 0.03), but the LLD trend rebounded by quarter three, demonstrating program resilience.

Conclusion/Implications: This study highlights ongoing racial variations in LLD, particularly affecting Hispanic individuals. Further research is warranted to explore how socioeconomic and citizenship status influence donation willingness and behavior. Additionally, the lasting impact of a widely publicized donor death in 2002 (among six total deaths) emphasizes the critical role of public and media perception, underscoring the need for efforts to promote a more positive narrative around LLD to support future growth.