# Pediatric-adult split liver transplantation: an ethical imperative and systems-based roadmap for global expansion

## TL;DR

The paper argues for expanding split liver transplantation to better serve both children and adults in need of liver transplants.

## Contribution

The paper introduces a five-point action plan to scale up pediatric-adult split liver transplantation globally.

## Key findings

- Split liver transplantation is as effective as whole-liver transplants but is underused due to logistical and policy barriers.
- Centralized splitting hubs and new transport methods could help normalize split liver transplants.
- Global pilot programs are suggested to test and expand the adoption of split liver transplantation.

## Abstract

This paradox emphasizes the urgent need to re-engineer transplant systems around pediatric-adult split liver transplantation (SLT). Despite being as effective as whole-liver transplants, SLT remains underutilized due to logistical and policy barriers. We believe that expanding SLT is not only clinically acceptable but a just and effective moral necessity. We propose a five-point action plan, including centralized splitting hubs, NMP-enabled transport, and global pilot programs, to transform SLT from an exception into standard practice.