Ethics of split liver transplantation: should a large liver always be split if medically safe?

Tae Wan Kim; John Roberts; Alan Strudler; Sridhar Tayur

doi:10.1136/medethics-2021-107400

Ethics of split liver transplantation: should a large liver always be split if medically safe?

J Med Ethics. 2021 Jul 9;48(10):738-741. doi: 10.1136/medethics-2021-107400. Online ahead of print.

Authors

Tae Wan Kim¹, John Roberts², Alan Strudler³, Sridhar Tayur⁴

Affiliations

¹ Ethics, Tepper School of Business, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA twkim@andrew.cmu.edu.
² Transplant Surgery, UC San Francisco Medical Center, San Francisco, California, USA.
³ Legal Studies and Ethics, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁴ Operations Management, Tepper School of Business, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA.

Abstract

Split liver transplantation (SLT) provides an opportunity to divide a donor liver, offering transplants to two small patients (one or both could be a child) rather than keeping it whole and providing a transplant to a single larger adult patient. In this article, we attempt to address the following question that is identified by the Organ Procurement and Transplant Network and United Network for Organ Sharing: 'Should a large liver always be split if medically safe?' This article aims to defend an answer-'not always'-and clarify under what circumstances SLT is ethically desirable. Our answer will show why a more dynamic approach is needed to the ethics of SLT. First, we discuss a case that does not need a dynamic approach. Then, we explain what is meant by a dynamic approach and why it is needed.

Keywords: ethics; transplantation.