Splitting livers - balancing the gain and the pain.
Division of donor livers has allowed effective expansion of the donor pool and has been associated with a reduction in the mortality of children awaiting liver transplantation. However, adult recipients of a split graft tend to have inferior transplant survival, compared with recipients of a whole graft. We have analysed the impact of the splitting programme at a particular centre on the life-years lost or gained in both adult and paediatric recipients. We estimate that at 1 year after transplantation, splitting livers has resulted in a gain of five life-years for the paediatric recipients with a loss of six adult patient years; at 5 years post-transplant, a gain of 25 life-years for the paediatric recipients balances a loss of 30 life-years for adult recipients. While this analysis is based on a number of assumptions, and so the results must be treated with caution, it does give rise to a number of ethical considerations which require open and public debate.
Collett
Dave
D
UK Transplant, Stoke Gifford, Bristol, UK. dave.collett@uktransplant.nhs.uk
O'Neill
John
J
Neuberger
James
J
D000293:Adolescent; D000328:Adult; D002648:Child; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D016016:Proportional Hazards Models; D016019:Survival Analysis; D020858:Tissue and Organ Harvesting / Q000379:methods*; D017211:Treatment Failure; D014850:Waiting Lists