Split liver network (SLN): an experimental internet-based system to expand organ pool.

Background - Split Liver Transplantation (SLT) has become a crucial option to maximize the liver pool, while Organ Procurement Organisations (OPOs) usually allocate whole livers to single centers. In 2003, Italian Ministry of Health funded the ‘SITF’ project with the goal to establish sharing criteria for Split Liver Transplantation for two adults (SLT A/A), involving Italian transplantation centers, the North Italy Transplant OPO and the Italian National Transplant Center. Methods - SITF group defined donor/recipient inclusion criteria, setting minimum graft/recipient weight ratio (GRWR) at 1.2%. Donors and recipients on waiting list were shared on an Internet secured Web-based application (Split Liver Network, SLN). SLN performs realtime matches between the registered donor and all patients on the bases of GRWR, displaying a size-based list of matched donor/patients, figuring hemiliver allocation once the whole organ is referred to owner Center. Results - In the 2005 period, 47 donors and 124 patients were entered by nine centers, and six hemiliver allocations for three SLT A/A procedures were performed. By retrospective simulation of 32 donors and 613 recipients in the NITp area, matchable recipients were available for all donors, while blood group frequency seemed a determining factor, more than donor body weight. Comments - SLN hemiliver allocation might increase matching possibilities, offering a timely transplant for recipients of rare group, small-size or in need of short wait. Our experience suggests that such an environment may be helpful to share a macroregional pool of liver recipients and to optimize SLT.