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October 8, 1997

Using one liver to save two lives: University of Washington expands split-liver transplant program

In an effort to make maximum use of a scarce resource, University of Washington Medical Center is now offering split-liver transplants — an effort that could save up to 26 more lives each year.
The expansion is possible due to modifications in the technique for removing livers from donors that will reduce damage to the organ and increase success rates for recipients.

“This change will allow us to utilize every organ to the greatest extent possible and help more of the many patients in dire need of a liver,” said Dr. James Perkins, surgeon and director of Transplantation Services at UWMC.

The split-liver transplant procedure allows one donated liver to be divided and used by two patients, usually an adult and a child, although it may also work for two small adults. Once transplanted, the split liver will grow to normal size in the patient’s body.

Perkins notes that not every organ received for transplant will be used for this double transplant procedure. To ensure that organs are in top condition, livers received from donors over age 45 will not be split.

To reduce possible damage to the organ, UW surgeons will now split the liver while it is still in the donor’s body, rather than removing the entire organ before splitting. Perkins explained that this procedure is similar to that performed when a portion of a living donor’s liver is removed for direct transplantation.

When splitting the liver, surgeons must tie off up to 400 small veins to stop bleeding. Perkins noted that the in-body technique reduces handling of the liver and the need to place it on ice for splitting. It is also much easier to detect and control blood flow.

“With this process, the organ is removed in the best possible shape, helping to ensure the transplant will be successful,” Perkins explained.

Collaboration with Children’s Hospital and Medical Center, where pediatric transplants are performed, makes it possible to perform the two transplant procedures simultaneously.

The number of people in need of a liver transplant continues to grow at rates far exceeding the number of organs donated. Last month, approximately 8,698 people throughout the nation were on the waiting list for a liver transplant. In 1996, a total of 4,058 liver transplants were performed.

“The number of people needing a transplant has been growing from 20 to 40 percent each year, while the number of donors has only increased 2 to 3 percent,” noted Perkins. “About 15 percent of patients die while waiting for a liver transplant.”

Split-liver transplants procedures are being expanded at medical centers in Pittsburgh and New York as well as in Europe. The UW conducted its first split-liver transplant in 1993, and has performed approximately five such procedures since that time.

The University of Washington Transplantation Program has become a recognized leader in transplant services in the Northwest, offering kidney, heart, cornea, bone and bone marrow, skin and adrenal tissue, liver, pancreas, single and double lung and heart-lung transplants. Last year, approximately 200 transplant procedures, including 67 liver transplants, were performed at UWMC.