Splitting Donor Livers in Half ‘Would Shrink Waiting List Deaths of Children’

If doctors were allowed to treat two patients by splitting a donor liver in half, the number of children dying while on waiting lists would be eliminated.

The procedure has been avoided because of the risks that used to be associated with it but according to researchers at Boston Children's Hospital, splitting livers in two is safe and could save double the number lives for every organ donated.

Livers are able to regenerate themselves so they can be divided without risk of failure.

The researchers said the organ could be cut unequally, allowing the smaller part to go to a child while the larger section goes to an adult.

Heung Bae Kim, lead author of the study, said: "Infants waiting for a donor liver have the highest waiting list mortality of all liver transplant candidates and dozens of children die each year waiting for size-appropriate organs to become available.

"If we can increase the number of split livers to just 200 a year, which would still affect less than 4% of the total number of livers transplanted each year, it would save virtually every small child waiting for a new liver."

Researchers looked at liver transplant survival rates over a 15-year period. Of the 62,190 studied, 889 received partial grafts from a split liver.

Findings showed that from 2002, the risk of graft failure in split liver transplants was around the same as those who were given the whole organ.

Ryan Cauley, first author of the paper, said: "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.

"Because risks once associated with this technique are now negligible, if a centre has a patient waiting for a liver and it has access to a split graft, there's no reason not to accept it."

Risks now negligible

The team is calling for a change in how livers are allocated, saying children should be placed at the top of the waiting list so surgeons have the option to split the organ when it becomes available - once it has been divided, the larger portion can go to the next adult on the list.

"There are around 500 to 600 paediatric liver transplants done each year in the United States, with split liver transplant only accounting for 120 of the total number," Kim said.

"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 maximising access to organs for children, it's my hope that implementing changes that would benefit children without harming adults would be considered favourably."

In the UK, there has been a split liver transplant programme for some time, but this has not helped to prevent people dying on waiting lists as there are still too few donors.

Professor James Neuberger, Associate Medical Director for organ donation and transplantation at NHS Blood and Transplant said: "The UK has had a very active split liver transplant programme in place for many years. Split liver transplants allow two patients to benefit from one donated liver.

"The liver is split into two unequally sized portions, with the smaller segment allocated to a child and the larger segment to an adult.

"The designated liver transplant units in the UK work collaboratively, supported by NHS Blood and Transplant, to ensure as many patients as possible in the UK benefit from a transplant and we have clear policies in place for determining the allocation of organs.

"In 2012/13, 784 deceased donor liver transplants were performed in the UK and 112 of these were split liver transplants.

"There are currently 479 people in the UK waiting for a liver transplant, but the unfortunate reality is that some of these patients won't get the organ they need in time as there is a shortage of organ donors in the UK."