Splitting Livers For Transplant Shown to be Safe, Study Says

A Boston doctor wants to change the donor allocation policy.

Split liver transplantation does not increase risk of failure in either recipient, according to new research from Boston Children’s Hospital published online in the Journal of the American College of Surgeons. This allows surgeons to save two lives from a single donated organ.

Donated livers can be surgically split into two portions of unequal size because of liver’s regenerative nature. The smaller part would go to a child awaiting transplant and the larger portion to an adult. “Infants waiting for a donor liver have the highest waitlist mortality of all liver transplant candidates, and dozens of children die each year waiting for size-appropriate organs to become available,” says the study’s lead author Dr. Heung Bae Kim director of Boston Children’s Hospital’s Pediatric Transplant Center, in a press release. “If we can increase the number of split livers to just 200 a year, which would still affect less than four percent of the total number of livers transplanted each year, it would save virtually every small child waiting for a new liver.”

That’s why Kim is calling for change. Boston Children’s Hospital says that based on his research:

Kim is advocating for changes in how donor livers are allocated—automatically placing infants and small children at the top of the liver waitlist, thereby giving pediatric transplant surgeons the option to split the first graft to become available. Once the liver has been split, the smaller portion is transplanted into a child and the larger portion is transplanted into the next appropriate adult on the list.

In addition to saving young patients, Kim’s proposed amendments to the allocation process could take place without sweeping change, affecting only an extremely small portion of available grafts. “There are around 500 to 600 pediatric liver transplants done each year in the United States, with split liver transplant only accounting for 120 of the total number,” Kim says. “By splitting just 80 more livers a year, it would make grafts available to virtually every small child on the waitlist. Given the current national debate on maximizing access to organs for children, it’s my hope that implementing changes that would benefit children without harming adults would be considered favorably.”

Boston Children’s researchers looked at data from the United Network for Organ Sharing over a 15 year period (1995-2010). They studied the graft survival rates of 62,190 first-time adult deceased-donor liver transplant recipients, 889 of whom received partial grafts from a split liver transplant. The study concluded that with the exception of a small, very sick population of patients, adults who receive a split graft can expect to fare as well as those who received a whole organ.