Every year, approximately 8,500 people die waiting for a new liver because their miracle didn't come in time. There simply aren't enough donor organs to save everyone. Promising research into transplants from living donors and animals may offer hope in the future--but all too many patients just don't have the time to wait.

However, a new split liver transplant surgery performed at UAB is saving more lives with the organs that are available today.

"Liver tissue has a unique ability to quickly regrow itself from half to full size," Devin Eckhoff, MD, said. "When the volume of the donor organ is adequate, we can split it to save two patients. In the past, split liver transplants have primarily been shared between one adult and one child. Now we are also transplanting into two smaller adults."

Saving the lives of two women, the first adult split transplant performed at UAB began shortly before noon and was completed at 2:00 am the next morning. Multiple transplant teams led by Eckhoff, Derek Dubay, MD, Stephen Gray, MD and Jared White, MD, participated in the procedure.

Devin Eckhoff, MD

"In addition to advances in anesthesia and perioperative care, a key factor that makes split transplants possible is the surgical technique of splitting the liver while it is still inside the donor," Eckhoff said. "This makes determining the structure of the blood vessels easier. We can compare the donor liver to blood supply structures in recipients to make sure the blood flow and venous drainage will be good. We can also have a microvascular surgeon standing by to create better flow."

Liver tissue by its nature can be difficult to split. Dubay and White performed the splitting procedure using a specialized tool that looks something like a water pick to carefully divide the liver tissue without damaging the underlying vascular structure. An ultrasonic tool can also be used. Adding to the complexity of this case was the unusual structure of the donor liver, which had four outflow veins rather than the usual one.

Since the splitting procedure takes two surgeons about four hours to complete, it typically begins before other teams come in to prepare kidneys, eyes, lungs, heart and other organs for transplant.

"Splitting the liver reduces the time the organ is viable for transplant, so it's helpful if both the donor and recipients are geographically nearby or in the same location," Eckhoff said. "Dr. Gray and I, and our transplant teams of anesthesiologists, nurses and operative support were standing by with each patient and ready to begin the 8-hour procedures.

Split liver transplants are usually best suited to patients who are smaller than average, particularly the patient receiving the left side of the liver, which is smaller than the right. The transplanted split liver typically grows up to 85 percent of its original size within a month, and in the UAB patients, the increase in size was soon visible on CAT scans.

The liver plays a central role in many body processes, making healthy function essential to life.

"Two of the most common reasons patients need a new liver are damage from illnesses like Hepatitis C or a fatty liver that has failed from the effects of metabolic syndrome and related disorders. We're seeing that more often now," Eckhoff said. "Damage can be caused by autoimmune diseases or toxic substances including drugs or alcohol. In recent years, we haven't been seeing as much damage from alcohol as might be expected. Patients whose condition is alcohol-related have to be off alcohol at least six months before surgery. We also aggressively treat any other factors that contributed to damage in the original organ so we can give the new liver the best possible chance for healthy function.

"The liver is more forgiving than many organs, with less rejection, and we can treat it for better long term outcomes."

For the first two to four weeks, split liver transplant patients are monitored to watch for bile leaks and bleeding as their new liver grows. After that, follow-up is generally the same as with full organ transplants.

The patient's primary doctor and other physicians who provide future care should be careful to avoid drug interactions and to monitor factors like diet that may have played a role in the failure of the original liver.

"We're glad to be saving more lives, but so many more could be saved if only more organs were available." Eckhoff said. The true heroes in this story are the donor who made his wishes known, and his family, who honored his wishes and saved multiple lives. We encourage everyone to consider being an organ donor and discussing that choice with their family so that if and when the time comes, they can give the gift of life to others who will live on."