Split Liver Workshop Opens New Doors for Surgeons and Patients

Transplant experts at Children’s Hospital Colorado are working to maximize liver transplants in the United States. By training a new generation of surgeons in a technical surgical approach, they could reduce the wait time for liver transplants.

At Children’s Hospital Colorado, roughly 50% of all liver transplants come from living donors. The remaining 50% of pediatric candidates must wait for a deceased donor. Because the vast majority of these donors are adults with livers larger than children need, kids generally only receive a small part of a deceased donor’s liver. Unfortunately, that often means a perfectly usable section of these livers is discarded. But that doesn’t have to be the case.

Very few centers across the world, including Children’s Colorado, perform a technique in which a deceased donor’s liver can be split. That means that when a deceased donor’s liver is allocated to a child, the team can undertake the meticulous work of splitting the liver into two sections, with the child receiving a portion and an adult or larger pediatric patient receiving the other.

This approach, though relatively uncommon in the U.S., is highly effective in reducing wait times and ensuring fewer patients die while waiting for a viable organ. For infants, who have high mortality rates on the liver transplant waitlist, this is especially critical. According to Children’s Colorado transplant surgery fellow Dor Yoeli, MD, increasing the number of split liver procedures is beneficial to both adults and children because it is a safe approach and shortens the waitlist overall.

“There has been research showing that being willing to accept a split decreases wait list mortality by as much as 70% for the smallest babies and also decreases the waiting list mortality for adults by 40%,” he says. “There are a lot of reasons to collaborate, and everyone's goal is to get the wait list mortality to zero for everyone. The gap is closable if we split all the livers that are splitable.”

One of the biggest barriers to increasing the frequency of split liver procedures is a lack of formal training in the procedure itself. Because it is relatively uncommon, few surgeons have the experience needed to perform the technical split. At Children’s Colorado, surgeons have gained the expertise necessary to split livers through the living-donor liver program, which has been running successfully since 2016. As part of this program, surgeons have had the opportunity to practice the techniques necessary to split a liver inside a donor’s body.

Dr. Yoeli is working alongside Megan Adams, MD, Surgical Director of Pediatric Abdominal Transplant and surgeons in Pittsburgh and Toronto are working to create a new training opportunity to help others gain some of this valuable experience. Supported by grant funding from the Donor Alliance Foundation and the Society of Pediatric Liver Transplantation, or SPLIT, the team is building a one-day training course inspired by a similar program held in Barcelona each year.

The event will be held on March 8, 2027. In the meantime, the team is busy organizing lectures by leaders in the field and preparing for live demonstrations and hands-on practice for participants.

“It’s a hands-on chance to learn the planes of the liver and understand where to cut the vessels, how to share the liver, which part of the vessels goes to the adult side, which should stay with the pediatric side,” Dr. Yoeli says.

Beyond teaching practical skills, the team hopes the training gives learners the foundation they need to move the needle toward more liver splits nationwide.

“I will say these are complicated operations that no one should expect to be able to do on their own after just attending one workshop,” Dr. Yoeli notes. “But it will create this network of collaboration, we think, where people will know each other, have an interest in split, and hopefully want to work together to split a liver if the opportunity arises.”