Developments in Brief : Surgeon Trims Adult Livers to Fit Children

A Chicago transplant surgeon is trimming adult livers to fit them into dying children, a procedure that he says may be the only hope for many youngsters because of the tremendous shortage of small organs.

“As long as there is a slight chance of survival, we should go ahead,” said Dr. Christoph E. Broelsch of the University of Chicago. “It’s a way out of the scarcity of organs.”

In the last four years, he has pared down nine livers, some of them by more than half, and transplanted them into children under 4, some of whom had only hours left to live. Four of the children are still alive.

“They were all a last resort for a dying patient,” he said in a paper presented at a recent meeting of the American Society of Transplant Surgeons.

The liver is a regenerative organ and can grow along with the rest of the body after being reduced in size, Broelsch said.

Dr. John McDonald, president of the United Network for Organ Sharing in Richmond, Va., described Broelsch’s findings as encouraging. “There’s a real need for such a procedure,” he said.

More than 300 people are awaiting liver transplants in the United States; nearly half of them are under 11. Broelsch estimated that 25% to 50% of all children waiting for livers die before getting one.

Most donor organs are taken from people who suffer brain death, such as accident victims. The number of child organ donors is “very, very, very small” because brain death is less common among children, Broelsch said.

Many U.S. surgeons have been reluctant to try segmental liver transplants because of concern about the risk of increased bleeding and infection, but the procedure is being performed with growing success also in Europe, particularly in Belgium and France, he said.