Split liver transplantation carries no increased risk of failure in either recipient, according to a new study published in the Journal of the American College of Surgeons. The process, whereby two partial grafts can be obtained from a single donated organ, could virtually eliminate waitlist mortality among young children in need of a new liver.

The transplantation relies on the organ's regenerative abilities. A donated liver from an adult or adolescent can be surgically split into two different sizes and allocated to an adult recipient as well as an infant recipient.

"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," said lead author Heung Bae Kim, MD, director of Boston Children's Hospital's Pediatric Transplant Center. "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."

In light of the findings, the research team is calling for an overhaul of current donor organ allocation policies. Infants and chidren, who only require a small segment of the split liver, could automatically be placed at the top of the donation waitlist, thus giving surgeons the option to save two lives with every donated liver.

The researchers looked at graft survival rates in 62,190 deceased-donor liver transplant recipients from 1995 to 2010. 889 of the recipients had received a split graft. The team found that from 2002 forward, the risk of failure in split grafts was comparable to that of whole grafts.

"After an extensive review of the data, it's clear that in the current era, 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," said first author Ryan Cauley, MD, MPH. "Because risks once associated with this technique are now negligible, if a center has a patient waiting for a liver and it has access to a split graft, there's no reason not to accept it."

The proposed adjustments to the allocation policy could be implemented without significant administrative changes, as they only affect a small percentage 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 continued. "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."


M.B. Majella Doyle, Erin Maynard, Yiing Lin, Neeta Vachharajani, Surendra Shenoy, Christopher Anderson, Mark Earl, Jeffrey A. Lowell, William C. Chapman. "Outcomes with Split Liver Transplantation Are Equivalent to Those with Whole Organ Transplantation." Journal of the American College of Surgeons. 1 July 2013 (volume 217 issue 1 Pages 102-112 DOI: 10.1016/j.jamcollsurg.2013.03.003)