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Split liver transplant guidelines developed by UNOS/OPTN ethics panel.

Responding to the steady increase in US transplant programs practicing split liver transplantation, the United Network for Organ Sharing/Organ Procurement and Transplantation Network Ethics Committee has developed a set of voluntary guidelines for programs to follow.

"One of the paramount responsibilities of transplant surgeons is to inform recipients as to the current practices of their transplant program regarding split liver transplantation, the risks involved, the potential for increased morbidity requiring additional interventional/surgical procedures and hospital stay, and the program's outcome data regarding these procedures," the committee writes in the paper "Split Vs. Whole Liver Transplantation OPTN/UNOS Ethics Committee White Paper.

The committee emphasizes that the discussion must take place at a time when the recipient is not under undo pressure to accept a split liver, and should avoid making the offer "in the immediate pre-transplant period" when a donor liver becomes available.

In addition, the white paper stresses that it is the "unequivocal right" of the patient to refuse a liver segment that has been allocated without being penalized. However, by refusing, the patient does not automatically gain entitlement to receive a whole liver.

Here are the considerations the ethics committee feels are necessary at this time to ensure responsible and ethical liver transplantation:

1.The transplant community has an ethical obligation to maximize the number of potential recipients successfully transplanted. Splitting medically suitable livers is therefore ethically proper.

2.Patients have the clear and unequivocal right to refuse an offered organ, including a liver segment.

3.An overriding responsibility of transplant surgeons is to inform potential recipients of the current practices of their programs regarding split liver transplantation.

4.Patients have the right to decide which risks they are willing and unwilling to accept regarding their own care, based on the best currently available information regarding:

*the potential of the split liver procedure for increased morbidity and longer hospitalization;

*the possibility of further invasive interventions;

*experiences with split versus whole liver transplantation in the transplant center where they are listed and in other transplant centers.

5.Informed consent discussions should take place early: when potential recipients are initially listed, or, for those patients already listed, when a split liver program is initiated.

6.Patients who decide against accepting a split liver in early discussions should nevertheless be offered the option at the time a split liver becomes available, insofar as patients may change their minds with changing circumstances.

7.All parties involved in the transplantation process must understand that there is no claim of ownership of an organ by a potential recipient, transplant center/program, or transplant surgeon. There is, however, a stewardship responsibility inherent in this process. Each person involved in the recovery, replacement, and transplantation of an organ is a guardian rather than owner of that particular organ.

The entire paper has been, or will soon be, posted on the UNOS Web site:
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Title Annotation:United Network for Organ Sharing/Organ Procurement and Transplantation Network Ethics Committee
Comment:Split liver transplant guidelines developed by UNOS/OPTN ethics panel.(United Network for Organ Sharing/Organ Procurement and Transplantation Network Ethics Committee)
Publication:Transplant News
Geographic Code:1USA
Date:Feb 14, 2003
Previous Article:Liver recipient almost dies from nut allergy transmitted from donor.
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