Two-for-One Transplant Makes Livers Go Further

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How best to allocate scarce donated body parts has been a tricky question for doctors and hospitals ever since organ transplantation began. Now the national nonprofit organization that sets organ allocation policies across the United States, the United Network for Organ Sharing, has announced two major changes regarding liver transplants. One will mean doctors can get more mileage out of existing resources; the other will give priority to the sickest patients.

Taking advantage of the fact that a healthy liver is the only internal organ that can regenerate, UNOS decided to allow qualified centers to split donated livers in two so that one portion can be donated to an adult and a smaller section to a child. The second decision redefines waiting list priorities according to broader geographic parameters: Previously, if there were no really urgent cases in a local area, the organ would go to a less ill patient in that area rather than being sent to someone in worse condition farther away. The new priorities came after pressure from the federal Department of Health and Human Services.

The new split-transplant policy is expected to help more children get off the waiting list while still accommodating adults in need of a new liver. Studies indicate that there is no medical downside to receiving a split liver. "But this is something that can be done only at certain centers where there are doctors with special expertise," says TIME medical columnist Christine Gorman. "Itís not just a matter of slicing a liver in two." The redesigned waiting list priorities, meanwhile, says UNOS, reflect the organizationís belief that it is more critical to address the needs of the most urgent liver patients first and to spread those first-priority allocations more broadly.