White Paper: Split Versus Whole Liver Transplantation Ethics Committee

What is this resource? Revised white paper from the Ethics Committee Committee had been tasked with updating a prior version written many years earlier Provides an ethical analysis and recommendations regarding split-liver transplantation Target Audience: Transplant hospitals or OPOs considering split liver transplantation Candidates who may be evaluating split-liver transplantation versus whole-liver transplantation Beginning in 1993, the Ethics Committee (the Committee) developed a series of white papers that are available through the OPTN website. The purpose of the white papers is to provide guidance and to stimulate discussion around important subjects. In 2014, the Committee began a systematic review of these white papers to evaluate if each of the white papers were accurate and relevant, and therefore valuable resources for the transplant community. The original white paper addressing split liver allocation was determined to require revision it contained outdated terminology, and other information that was not accurate.

Changes to the white paper Committee completed a substantive revision of this white paper addressing: Ethics of optimal allocation Current allocation of deceased donor allografts Splitting a deceased donor allograft Ethics of modifying allocation and practice to promote split liver transplantation Informed consent Center expertise Additional challenges Over the past year, the Committee completed a substantive revision of the white paper addressing split liver allocation which includes recommendations for changes to the liver allocation, an extensive set of citations, new appendices, and new illustrations. The topics addressed in this white paper include the those items displayed on the screen.

How will members access this resource? Members will be able to access this resource through the OPTN website Current white papers are available under the Resources tab, select Ethics

Questions? Peter Reese, M.D. Committee Chair peter.reese@uphs.upenn.edu Lee Bolton Committee Liaison lee.Bolton@unos.org

Supporting Evidence January 1, 1995 – December 31, 2015 Total Deceased Donor Liver Transplants 113,394 Total Split Liver Transplants 1546 1.36% Split Liver Allograft Transplants to Pediatric Recipients 1439 93% Whole Liver Transplants to Pediatric Recipients 107 6.8% The following slides are not expected to be presented during the regional meeting, but provide evidence if needed to address questions. [I’m going to give you a few minutes to review this table. As you can see the total number of split liver transplant per year is low and most split liver transplant benefit pediatric recipients

Supporting Evidence New split liver criteria were adopted in November 2006. From 19 months pre-adoption through 19 months post-adoption (April 2004–June 2009) 2,247 (10.3%) of 21,832 deceased donors met the criteria; 218 (1.1%) of 19,644 livers transplanted were split-liver transplants. The split liver criteria were adopted in Nov. 2006; from

Supporting Evidence From June 1, 2001 through Dec. 31, 2015, 129,276 (85%) of 151,250 adult registrations for liver transplantation noted a willingness to accept a split liver at listing In 2015, 10,100 (90%) of 11,256 adult registrants for liver transplantation noted a willingness to accept a split liver at listing From June 1, 2001 through Dec. 31, 2015, there were 151,250 adult registrations for liver transplantation; at listing, 129,276 (85%) noted a willingness to accept a split liver In 2015, 10,100 (90%) of 11,256 registrants noted a willingness to accept a split liver.