The integration of terrestrial- and satellite-based quantum key distribution (QKD) experiments has markedly advanced global-scale quantum networks, showcasing the growing maturity of quantum technologies. Notably, the use of unmanned aerial vehicles (UAVs) as relay nodes has emerged as a promising method to overcome the inherent limitations of fiber-based and low-Earth orbit (LEO) satellite connections. This paper introduces a protocol for measurement-device-independent QKD (MDI-QKD) using photon orbital angular momentum (OAM) encoding, with UAVs as relay platforms. Leveraging UAV mobility, the protocol establishes a secure and efficient link, mitigating threats from untrusted UAVs. Photon OAM encoding addresses reference frame alignment issues exacerbated by UAV jitter. A comprehensive analysis of atmospheric turbulence, state-dependent diffraction (SDD), weather visibility, and pointing errors on free-space OAM-state transmission systems was conducted. This analysis elucidates the relationship between the key generation rate and propagation distance for the proposed protocol. Results indicate that considering SDD significantly decreases the key rate, halving previous data results. Furthermore, the study identifies a maximum channel loss capacity of 26 dB for the UAV relay platform. This result is pivotal in setting realistic parameters for the deployment of UAV-based quantum communications and lays the foundation for practical implementation strategies in the field.