In a single center, morbidity after living liver donation strongly correlates to center experience. Despite the additional risks associated with temporary reduction of liver function, this experience enabled the team to bypass part of the learning curve when starting right lobe donation. Specific training of the surgical team and coaching by an experienced center should be implemented for centers offering this procedure to avoid the learning curve.

Full-right/full-left splitting of the liver offers a chance to overcome the severe shortage of donor organs. During this procedure, the splitting surgeons are always faced with the question of how to share the middle hepatic vein (MHV), since this vein drains parts of both halves of the liver. Consequently, we developed a procedure that splits the MHV, thus creating an MHV on both grafts. In this short article, we report on this splitting technique and our first initial experience. (Liver Transpl 2005;11:350-352.) D ue to the increasing shortage of liver grafts for transplantation seen in the last 2 decades, various surgical efforts have been made to solve this problem. One solution is the technique of full-right/full-left splitting for 2 adult recipients, which was first described by Colledan et al. 1 in 1999. The authors described splitting the liver in a similar way as in living donation, which leaves a right liver lobe comprising segments V-VIII and a left lobe consisting of segments I-IV, leaving the vena cava and the middle hepatic vein (MHV) with the left lobe. However, using this technique, the right graft is endangered by kinking or narrowing of the venocaval anastomosis and loss of drainage of the short retrohepatic veins draining directly into the vena. Consequently, we described the split cava technique, in which the vena cava is shared between both grafts. 2 The principle is to provide a vena cava patch on both grafts so that the venous outflow, not only of the main hepatic veins but also of segment I on the left side and the short retrohepatic veins on the right, stays in continuity with the graft, thus avoiding the above problems. However, a problem that remains unsolved is the possible congestion of segments V and VIII on the right graft if they are mainly drained via the MHV. This can lead to massive congestion of the right median sector, followed by prolonged ascites and severe liver dysfunction, as described by Lee et al. 3 after transplanting right grafts without a MHV in living donor liver transplantation. In living donor transplantation, several solutions have been proposed, including venous reconstruction and partial or complete preservation of the MHV to the right side. While the first solution has the disadvantage of technical complexity, the second results in a reduction in size of the already small left graft.We take advantage of the fact that in deceased donor transplantation, full use of the anatomy can be made, by splitting the MHV, thus creating a common venous outflow of the whole right or left lobe and simplifying the subsequent implantation of the graft. Patients and MethodsOn July 17, 2002, and October 26, 2002, respectively, we performed a full-right/full-left ex situ split procedure with splitting of the MHV. Both deceased donor liver grafts were from young, healthy donors and of excellent quality. The donor in the first case was a 22-year-old man with a body mass index of 22, who spent 10 days in the intensive care unit (ICU), but with no cardiac arrest or resuscitation eve...

While on the one hand, high standards of the evaluation process must be guaranteed, insufficient reimbursement on the other should not lead centers to reduce either quantity or quality of necessary examinations entered in the evaluation protocol.

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