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Split liver transplant: Saving two lives with one donated organ

A split-liver transplant can save two lives with a single donated liver. Transplant Surgeon Srinath Chinnakotla, MD, is on a mission to make the under-used procedure more common.
Pamela Davies (left), poses with Clinical Transplant Social Worker Susanne Hollister (right). Davies is one of a relatively small number of people to receive a split liver transplant. During a split liver transplant procedure, surgeons divide a deceased donor's liver into two sections, which are transplanted into two separate recipients.

In February 22, 2013, Pamela Davies entered the hospital with a failing liver and just days left to live.

Expecting the worst, Davies had already put her affairs in order. She said good-bye to her loved ones, then gave away her clothes, her books and her extensive music record collection.

Less than one week later, the then-45-year-old Minneapolis woman left University of Minnesota Medical Center with two-thirds of a donated liver and a whole new life.

Davies is part of a small group of patients in the country who have received a split liver transplant. During a split liver transplant, surgeons divide a deceased donor’s liver into two parts and implant the sections into two recipients instead of one. An adult and a child can also share a split liver transplant. In such cases, surgeons give two thirds of the liver to the adult, while the child receives the other third.

“Since the transplant, I truly feel better than I have in my entire life,” Davies said. “The split liver transplant gave me a completely new existence I never thought possible.”

One liver, two lives

Split liver transplants remain a relative rarity in the United States, though surgeons developed the procedure over 25 years ago. In 2015, split liver transplants accounted for less than 15 percent of all pediatric transplants.

Transplant Surgeon Srinath Chinnakotla, MD, the surgical director for the University of Minnesota Health liver transplantation program, would like to see that percentage grow.

“It’s imperative that we increase the number of split liver transplants. It’s for the common good,” he said. “Every time we split a liver, we save two lives instead of one.”

Learn more about liver transplant surgery through University of Minnesota Health.

An increased level of medical expertise is required to perform a split liver transplant, which may be one reason why the procedure remains uncommon, said Chinnakotla, who performed Davies’ transplant procedure. Not all deceased donor livers are suitable for the procedure, either. There is a slight risk for bile duct and arterial complications following a split liver transplant, but that survival rates for both standard whole-liver transplants and split liver recipients are equal.

Davies battled obesity and a metabolic disorder caused by Hashimoto’s thyroiditis for much of her life. In August 2011, she was hospitalized for liver failure and was told she had less than a year to live. That same visit, she was diagnosed with nonalcoholic steatohepatitis—a form of nonalcoholic fatty liver disease. At the time, she weighed more than 200 pounds.

Under the supervision of her care team, Davies shed 100 pounds over 19 months and eventually met the qualifications for the liver transplant list. During the full year she remained on the list, Davies’ condition continued to worsen as she suffered from debilitating complications related to her liver failure.

“All indications were that I was getting too sick to transplant,” Davies said. “I saw it on my doctors’ faces every time I went to an appointment. We all knew it was down to the wire. I saw no end in sight to the deterioration happening in my body. I thought my time had come.”

“Forever grateful”

In February 2013, she received a call from Chinnakotla, who told her they had found a suitable liver. Her procedure, he said, would be a little different: She and another transplant recipient would share a single liver. There was no time left to wait in line for the next donated organ.

“While I was on the phone with the doctor, I dialed a taxi-cab on the other line to take me to the hospital for the transplant,” Davies said.

Chinnakotla split the liver, giving two-thirds of it to Davies and one-third to a child. The procedure went smoothly and Davies was released from the hospital six days later. She felt well within three months and fully recovered within a year. Fast forward four years, and Davies still has not experienced any complications.

The child receiving the other portion of the liver has also recovered smoothly and is now living a healthy life, Chinnakotla said.

After the transplant, Davies became an organ donor advocate and transformed her body through a healthy diet and fitness. She is now an avid runner, cycling enthusiast, strength trainer and meditation practitioner. She is also a certified professional coach and uses her experience to help others improve their own lives.

“I’m forever grateful for the humanity and ingenuity of the University of Minnesota Health care providers who saved me. On my first visit, my doctor said their slogan was, ‘We will find a way.’ My life is proof that it’s not just a slogan.”