COTA was founded in 1986 when a group of citizens began fundraising to get David McConnell, a two-year-old, onto a waiting list for a liver transplant. The group raised $100,000 in two months and David was placed on the list, but he died while waiting for his transplant.

The Children's Organ Transplant Assocation is a non-profit organization dedicated to ensuring that no child who needs an organ transplant is unable to receive one due to finances.

Every child who receives COTA assistance is screened to ensure that their history, medical status and financial situation are real and current and that without COTA's expertise, their health would be at risk. COTA includes doctors and hospitals in this process. Three local volunteers are also required to be eligible, including a trustee who will handle the finances and who cannot be a relative of the child.

Every dollar donated goes directly to verified and required medical services that are not covered by insurance or any form of government assistance. Donations are not taxed for the recipient, and are tax deductible for the donor. COTA runs its administrative work off the interest earned from donations; not a cent of any donation is ever redirected to the running of COTA itself.