Splitting donated livers shown to be safe, allowing doctors to save two lives from single organ

July 17, 2013, Children's Hospital Boston

Split liver transplantation carries no increased risk of failure in either recipient, allowing surgeons to safely save two lives from a single donated organ (graft), according to new research from Boston Children's Hospital published online in the Journal of the American College of Surgeons.

Due to their regenerative nature, livers donated by a deceased adult or adolescent can be surgically split into two unequally sized portions; the smaller segment is allocated to a young 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 Heung Bae Kim, MD, director of Boston Children's Hospital's Pediatric Transplant Center and lead author on the study. "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."

Based on his recent findings, (which includes research on how well children function with split livers) Kim is advocating for changes in how 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.

Analyzing United Network for Organ Sharing (UNOS) records, Boston Children's researchers looked at data compiled over a fifteen year period (1995-2010), studying the graft survival rates of 62,190 first-time adult deceased-donor liver transplant recipients, 889 of whom received partial grafts from a split . The research shows that from 2002 forward the vast majority of adults who received a split graft experienced a risk of graft failure comparable to those who received a whole graft.

"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," says Ryan Cauley, MD, MPH, first author on the paper. "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."

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 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."

Explore further: Split liver transplants for young children proven to be as safe as whole organ transplantation

Related Stories

Split liver transplants for young children proven to be as safe as whole organ transplantation

June 10, 2013
A new study shows that when a liver from a deceased adult or adolescent donor is split into two separate portions for transplantation—with the smaller portion going to a young child and the larger to an adult—the smaller ...

Obese donors increase risk of death for pediatric liver transplant recipients

August 1, 2012
Children undergoing liver transplantation are at greater risk of graft loss and death from adult organ donors who are severely obese according to research published in the August issue of Liver Transplantation, a journal ...

Many patients who die while awaiting liver transplant have had donor organs declined

November 5, 2012
The majority of patients on the liver transplant waitlist who died received offers of high-quality donated livers that were declined prior to their death, according to a new study in Gastroenterology, the official journal ...

Antioxidant improves donated liver survival rate to more than 90 percent

February 25, 2013
Researchers from Italy have found that the antioxidant, N-acetylcysteine (NAC), when injected prior to harvesting of the liver, significantly improves graft survival following transplantation. Results published in the February ...

Liver transplantation for patients with genetic liver conditions has high survival rate

April 5, 2013
Patients faced with the diagnosis of a life-threatening liver disease have to consider the seriousness of having a liver transplant, which can be a definitive cure for many acquired and genetic liver diseases. Among the main ...

Maternal liver grafts more tolerable for children with rare disease

January 3, 2012
Children with a rare, life-threatening disease that is the most common cause of neonatal liver failure – biliary atresia – better tolerate liver transplants from their mothers than from their fathers, according ...

Recommended for you

Drug may help surgical patients stop opioids sooner

December 13, 2017
(HealthDay)—Opioid painkillers after surgery can be the first step toward addiction for some patients. But a common drug might cut the amount of narcotics that patients need, a new study finds.

Children best placed to explain facts of surgery to patients, say experts

December 13, 2017
Getting children to design patient information leaflets may improve patient understanding before they have surgery, finds an article in the Christmas issue of The BMJ.

Burn victim saved by skin grafts from identical twin (Update)

November 23, 2017
A man doomed to die after suffering burns across 95 percent of his body was saved by skin transplants from his identical twin in a world-first operation, French doctors said Thursday.

Is a common shoulder surgery useless?

November 21, 2017
(HealthDay)—New research casts doubt on the true effectiveness of a common type of surgery used to ease shoulder pain.

Study shows electric bandages can fight biofilm infection, antimicrobial resistance

November 6, 2017
Researchers at The Ohio State University Wexner Medical Center have shown - for the first time - that special bandages using weak electric fields to disrupt bacterial biofilm infection can prevent infections, combat antibiotic ...

Obesity increases incidence, severity, costs of knee dislocations

November 3, 2017
A new study of more than 19,000 knee dislocation cases in the U.S. between 2000 and 2012 provides a painful indication of how the nation's obesity epidemic is changing the risk, severity and cost of a traumatic injury.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.