Ethical Issues in Split Versus Whole Liver Transplantation

Abstract

IntroductionSplit liver transplantation (SLT) allows two recipients, in current practice usually an adult and a child, to benefit from one deceased donor liver. Recent comprehensive studies confirm that split liver transplants generally lead to less favorable results for individual recipients, but also lead to more individuals getting the benefit of a liver transplant. Surgeons' pioneering advances in the operating room have left a classic ethical dilemma in their wake: where and how should the transplant community draw a balance between the rights and interests of patient A (an adult recipient), who is at the top of the transplant list, and patient B (most likely a pediatric recipient), who is somewhere down the list and will get a timely liver transplant if and only if patient A shares the donor liver. The purpose of this essay is to explore this difficult issue and also to propose general ethical and policy guidelines for the use of split liver transplants vis-à-vis whole liver transplants.

Split Liver Transplantation Using Hemiliver Graft in the MELD Era: A Single Center Experience in the United States

“…Indeed, is important to note that creating two extendedcriteria split grafts from one standard-criteria whole liver has been a matter of ethical debate (41,42). And while hemiliver SLT in the past may have led to less favorable results, it allows more adults the opportunity to receive a liver transplant (16,19,21).…”

Pediatric Liver Transplantation

“…The ethical issues that arise when using this large variety of surgically reduced allografts are complex [43]. Although whole, RSLTx, split-liver transplantation, and living-donor transplantation have similar survival and complication profiles in experienced centers, a significant learning curve exists in the complex donor and recipient operations.…”

Split liver transplantation in adults

“…Creating two extended criteria split grafts from a standard criteria whole liver raises a variety of ethical issues[33,34]. Since partial grafting per se is a risk factor for graft failure[35], one ethical issue is whether it is best to proceed with SLT or wait for a smaller whole liver graft.…”