The utilization of partial-liver grafts for transplantation of adults represents an evolution from strategies designed to increase pediatric organ supply that have been justified by increased organ-waiting times and morbidity of adult transplant candidates. These techniques, which include adult-to-adult living-donor and split-liver transplantation, mandate particular surgical and medical considerations, as partial-liver grafts predispose to unique complications resulting from anatomic variations, technical considerations, and recipient physiology. Adult-to-adult living-donor liver transplantation has been successfully reported throughout the world; however, the magnitude of the donor operation has resulted in serious morbidity and donor mortality that have stimulated an ethical debate as to the future of this procedure. The limitations encountered in the application of adult-to-adult, living-donor liver transplantation have renewed interest in the successful implementation of split-liver transplantation between two adults from one adult cadaver donor. This manuscript details current technical considerations for the performance of adult-to-adult living-donor and split-liver transplantation, summarizes current outcomes, and explores the ethical dilemma of living-donation.
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