REDUCED-SIZE LIVER-TRANSPLANTATION, SPLIT LIVER-TRANSPLANTATION, AND LIVING-RELATED LIVER-TRANSPLANTATION IN RELATION TO THE DONOR ORGAN SHORTAGE

Because of the shortage of cadaveric donors, three techniques of parti al liver grafting have been developed. These techniques are placed in perspective in relation to the organ shortage. Reduced size liver tran splantation (RSLTx) is widely used and has results comparable to those from whole liver grafting. However, this technique, while benefitting pediatric patients, reduces the adult donor liver pool. It also makes inefficient use of an available adult donor liver. In split liver tra nsplantation (SPLTx), the whole liver is used after bipartition for tw o recipients. The results are comparable to those of RSLTx. The proble m with SPLTx is that it is a very demanding technique applied only in centers with extensive experience with liver resection and reduction. Living related liver transplantation (LRLTx) yields excellent results; however, it places an otherwise healthy person at risk. It is argued that instead of performing risky operations on healthy persons, the he alth authorities should take specific measures to alleviate the organ shortage. In the meantime, SPLTx should be developed further because o f its optimal use of donor tissue. As for LRLTx, its excellent results and the present shortage of size-matched pediatric liver donors justi fy its use, at least for now.