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Related Experiment Video

Updated: Jul 11, 2026

Rat Model of the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Procedure

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Splitting livers - balancing the gain and the pain.

Dave Collett¹, John O'Neill, James Neuberger

¹UK Transplant, Stoke Gifford, Bristol, UK. dave.collett@uktransplant.nhs.uk

Transplant International : Official Journal of the European Society for Organ Transplantation

|September 14, 2007

Summary

Splitting donor livers for transplantation helps more children but may reduce life-years for adult recipients. This liver splitting strategy presents ethical considerations for public debate.

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Last Updated: Jul 11, 2026

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Area of Science:

Transplantation immunology
Hepatology
Surgical outcomes

Background:

Division of donor livers expands the donor pool, reducing mortality for children awaiting liver transplants.
Adult recipients of split liver grafts generally experience lower transplant survival rates compared to those receiving whole grafts.

Purpose of the Study:

To analyze the impact of a liver splitting program on life-years gained or lost in both adult and pediatric recipients.
To evaluate the net effect of liver splitting on patient survival and resource allocation.

Main Methods:

Retrospective analysis of liver transplant data from a single center.
Life-year analysis comparing outcomes for pediatric and adult recipients of split versus whole liver grafts.
Estimation of life-years gained or lost at 1 and 5 years post-transplantation.

Main Results:

At 1 year post-transplant, liver splitting resulted in an estimated gain of five life-years for pediatric recipients and a loss of six life-years for adult recipients.
By 5 years post-transplant, the cumulative gain of 25 life-years in pediatric recipients was offset by a loss of 30 life-years in adult recipients.
The analysis highlights a trade-off between increased utilization of donor organs for pediatric patients and potentially reduced outcomes for adult recipients.

Conclusions:

Liver splitting programs offer significant benefits for pediatric liver transplantation by increasing organ availability.
The strategy leads to a net loss of life-years in adult recipients, raising critical ethical questions.
Further public discussion is warranted to address the ethical implications of liver splitting in organ transplantation.