Living Donor vs Deceased Donor vs Split Liver Transplant — What Are Your Child’s Options?

Medicine Made Simple Summary

Children who need a liver transplant can receive a liver from a living donor, a deceased donor, or through a split liver transplant. A living donor gives a small part of their liver, which grows back in both donor and child. A deceased donor liver comes from someone who has passed away and donated their organs. A split liver transplant divides one donor liver to help two people. Each option has benefits, challenges, and different wait times. Understanding these choices helps families make confident decisions.

Why Families Need Clear Information About Donor Types

When parents hear that their child needs a liver transplant, one of the first questions they ask is, “Where will the new liver come from?” Understanding donor options is essential. Each type—living donor, deceased donor, and split liver—has unique advantages, risks, and timelines. Some options offer faster surgery. Others depend on organ availability. Knowing these choices early helps families prepare emotionally and medically for the transplant journey.

This article explains each donor option in simple, clear language so families can feel informed, confident, and prepared.

Why Donor Type Matters in Pediatric Liver Transplant

The Liver’s Unique Ability to Regrow

Unlike most organs, the liver can regenerate. This remarkable feature makes living donor and split liver transplants possible. Both the donor and the child can regrow a full liver from a partial graft. This means children are not limited only to deceased donors and may have more options for matching.

Why Children Benefit from More Donor Choices

Children often become very sick while waiting for a transplant. Their small size makes finding a perfect match harder. Having more donor options increases the chance of getting a transplant sooner, which can significantly improve outcomes.

Three Donor Types Explained Simply

• Living donor liver transplant

• Deceased donor liver transplant

• Split liver transplant

Each option has its own process, timeline, and benefits. Understanding these differences is the first step toward making an informed decision.

1. Living Donor Liver Transplant

What Is a Living Donor Liver Transplant?

A living donor transplant uses a portion of a healthy adult's liver—usually a parent, relative, or volunteer—to replace the sick liver in a child. The donor’s remaining liver grows back to normal size. The child’s transplanted portion also grows and functions like a full liver.

Who Can Be a Living Donor?

Donors must be healthy adults with compatible blood types, appropriate liver size, and no medical conditions that increase risk. Most donors are family members because they share genetics and often have matching blood groups. Some centers allow unrelated donors if they meet medical and psychological criteria.

Why Living Donor Transplants Are Often the Best Option for Children

• Shorter waiting time

• Better control over timing of surgery

• Better outcomes for many infants with biliary atresia

• Lower risk of complications in certain conditions

• Faster recovery

Because timing is predictable, the child can undergo transplant before becoming critically ill.

Risks for the Donor

Living donation is major surgery. Risks include

• Pain

• Bleeding

• Infection

• Bile leaks

Long-term outcomes for donors are excellent, and the liver typically regrows completely within months. Donor safety is the top priority.

Risks for the Child

The child may experience

• Rejection

• Infection

• Bile duct problems

These risks exist regardless of donor type.

When Living Donation Is Not Possible

• If the donor is medically unsuitable

• If blood types do not match

• If the liver size or anatomy is not compatible

• If the child’s condition requires urgent deceased donor transplant

2. Deceased Donor Liver Transplant

What Is a Deceased Donor Transplant?

A deceased donor liver comes from someone who has passed away and previously chosen to donate their organs. These organs are carefully matched to children based on blood type, size, urgency, and medical need.

How Children Receive Deceased Donor Livers

• Children are placed on a national waiting list

• Priority is based on how sick the child is

• Smaller children receive organs from pediatric or small adult donors

Placement on the list does not mean an exact time for transplant. Families often wait days, weeks, or months depending on availability.

Benefits of Deceased Donor Transplants

• No family member undergoes surgery

• Larger livers may be available for older children

• Often used for urgent, unexpected liver failure

• Suitable when living donor is not an option

Challenges With Deceased Donation

• Waiting times can be unpredictable

• Sicker children may need transplant sooner than organs become available

• The child may become unstable during the wait

Families must stay ready to come to the hospital as soon as an organ becomes available.

3. Split Liver Transplant

What Is a Split Liver Transplant?

A split liver transplant divides a deceased donor liver into two parts so it can save two people. Typically, the smaller left lobe goes to a child and the larger right lobe goes to an adult. Because children need only a small graft, this option increases the number of available organs.

Why Split Liver Transplants Are Important for Children

• More donor organs become available

• Children receive priority because their portion is smaller

• Outcomes in experienced centers are excellent

This option is especially useful for infants and young children.

Limitations of Split Transplants

• Not every liver can be split

• The donor must be healthy and size-appropriate

• Transplant centers must have expertise to perform the procedure safely

• Some cases still require whole livers

Suitability for Each Child

Doctors determine whether a split graft is appropriate based on the child’s size, condition, and urgency.

Comparing the Three Donor Options

Below is a simple, clear comparison to help families understand the differences.

Living Donor Transplant

• Predictable timing

• Often quicker

• Donor must be healthy

• Surgery for both donor and child

Deceased Donor Transplant

• No surgery for donor

• Wait time unpredictable

• Used in emergencies

• Dependent on organ availability

Split Liver Transplant

• One donor helps two recipients

• Often prioritized for children

• Requires special surgical expertise

• Not always possible

How Doctors Decide Which Donor Option Is Best

Medical Condition and Urgency

Children with sudden liver failure may need the fastest option available—often a deceased donor. Children with long-term disease like biliary atresia may do well with a planned living donor transplant.

Size and Blood Type Matching

Doctors match donors and children based on size, blood type, and anatomy. Small babies require very small grafts.

Liver Anatomy

Some donors have anatomical variations that make them unsuitable for splitting or for living donation.

Center Expertise

Not all centers perform living donor or split liver transplants. Centers with these capabilities offer more flexibility.

Which Option Has the Best Outcomes?

Living Donor Transplants Have Excellent Outcomes

• Children often experience

• Shorter waiting times

• Fewer complications

• Better survival rates in certain diseases

Deceased Donor Survival Is Also High

Deceased donor organs work well and are life-saving, especially in emergencies.

Split Liver Survival Is Similar When Performed at Experienced Centers

Studies show that outcomes are comparable to whole liver transplants when performed by specialized teams.

What Parents Should Consider Before Making a Decision

Health and Willingness of a Potential Donor

A willing donor must be medically suitable. Some parents, relatives, or family friends volunteer but may not meet criteria. This is normal and should not cause guilt.

Waiting List Risks

If the child is becoming very sick, waiting may be unsafe. Living donation may offer a faster solution.

Logistics of Donor and Child Surgery

Families must consider time off work, caregiving for siblings, and transportation during recovery.

Long-Term Care After Transplant

• Regardless of donor type, the child will need

• Lifelong follow-up

• Immunosuppression medications

• Regular labs

The donor type does not change long-term medication needs.

Conclusion

If your child is being considered for a liver transplant, ask your transplant team which donor options are available and why one may be better than another. Understanding these choices early helps you plan, ask informed questions, and feel confident in the path ahead. Your medical team will guide you through every step and support your family’s decisions.