In January 2022, a Cyprus toddler was refused a life-saving heart transplant due to the fact that his parents were refusing COVID-19 vaccination (in the setting of requirements for legal guardians to be present and vaccinated as a condition of their child's surgery). 1 Because Cyprus lacked a pediatric heart transplant program, the child was referred to hospitals in three other countries but all refused. The dilemma was eventually solved by a Greek hospital agreeing to place the child on their heart transplant waiting list; however, this case presents many dilemmas and tensions between autonomy and beneficence in the setting of the pediatric transplant journey and COVID-19. In 2020, in USA, 1766 children received life-saving solid organ transplants, matched from 860 pediatric organ donors. 2 Currently, there are 1900 children on the USA transplant waiting list. More than 500 children waiting for a donor organ are between 1 and 5 years old. 3 Children awaiting heart transplantation experience the single highest waiting list mortality compared with all other age groups and all other solid organs. In USA, a 6-year period study found 17% (533) of children with severe heart failure died, while on the heart transplant waiting list, 63% (1943) received a transplant, 8% (252) were removed from the waiting list due to recovery, and 370 (12%) remained alive on the waiting list at the time the study had finished. 4 POT is one of the most common therapies in the

A life-saving treatment, solid organ transplantation (SOT) has transformed the survival and quality of life of patients with end-organ dysfunction. The coronavirus disease (COVID-19) pandemic has impacted the practice of deceased and living donations worldwide by various resource shifting, including healthcare personnel and equipment such as ventilators and bed space. Our work explores the COVID-19 pandemic and global transplant data to create a statistical model for deducing the impact of COVID-19 on living donor and deceased donor transplants in the United States of America (USA). In severely impacted regions, transplant centers need to carefully balance the risks and benefits of performing a transplant during the COVID-19 pandemic. In our statistical model, the COVID cases are used as an explanatory variable (input) to living or deceased donor transplants (output). The model is shown to be statistically accurate for both estimation of the correlation structure, and prediction of future donors. The provided predictions are to be taken as probabilistic assertions, so that for each instant where the prediction is calculated, a statistical measure of accuracy (confidence interval) is provided. The method is tested on both low and high frequency data, that notoriously exhibit a different behavior.

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