Splitting Donated Organs

According to new research from Boston Children’s Hospital, doctors can safely split donated livers in two, giving the larger portion to an adult and the smaller one to a child, with no increased risk to either patient.

Stories of children like 10-year-old Sarah Murnaghan of Pennsylvania, who waited more than a year on a children’s lung transplant list before her parents lobbied to include her on the adult list, highlight the struggles of kids waiting for organs of the appropriate size.

"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 study 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."

Kim’s team examined records from 1995 to 2010 from the United Network for Organ Sharing. They looked at survival rates for more than 62,000 adults who received livers from deceased donors, 889 of whom received split liver grafts.

From 2002 onward, the data show that adults who received split livers had about the same risk of transplant failure as those who received whole organs. Similarly, Kim’s research has demonstrated that children can also function well with split liver 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 study co-author Ryan Cauley, M.D., M.P.H., in a press release. "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."

Based on his team’s findings, Kim is advocating for changes in how donor livers are parsed out. He recommends automatically placing infants and young children at the top of the donor waitlist, giving surgeons the option to split the first liver that becomes available between a youngster at the top of the list and the next appropriate adult.

Changing transplant allocation rules can be controversial. In the case of Sarah Murnaghan, a federal judge temporarily suspended the so-called "under 12" rule, which allows children under age 12 to receive adult donor lungs only after all qualifying adults and teens in the region have been considered.

In June, in response to the Murnaghan case, the Organ Procurement and Transplant Network's executive committee approved a one-year rule change to make severely ill children under 12 eligible for priority on adult lung transplant lists.

“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," Kim said.

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