In this World Shared Practice Forum podcast, Dr. Jeffrey Burns converses with experts Drs. Akash Deep, James Squires, and Barbara Wildhaber about pediatric acute liver failure and the intricacies of deciding when a child is unsuitable for liver transplantation. Discussing insights from their 2024 Lancet Child Health and Adolescent Health paper, they emphasize the importance of a multidisciplinary approach in evaluating clinical, biochemical, psychosocial, and ethical factors. The conversation highlights challenges with exclusion criteria, risks associated with severe multi-organ failure, and the necessity of balancing technical feasibility with overall patient prognosis, while also addressing the ethical implications of organ allocation. LEARNING OBJECTIVES - Identify key clinical and biochemical factors in evaluating pediatric liver transplant suitability - Discuss the ethical and logistical considerations impacting transplant decisions in critically ill children with liver failure - Summarize multidisciplinary approaches for determining when a child may be unsuitable for a liver transplant AUTHORS Akash Deep, MD, FRCPCH Director - Paediatric Intensive Care Unit and Staff Governor King's College Hospital, London Professor in Paediatric Critical Care King's College London James Squires, MD, MS Associate Professor, Pediatrician UPMC Children's Hospital of Pittsburgh Barbara Wildhaber, MD Professor University Hospitals of Geneva Chief Physician Child and Adolescent Surgery Swiss Pediatric Liver Center Jeffery Burns, MD, MPH Emeritus Chief Division of Critical Care Medicine Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital Professor of Anesthesia Harvard Medical School DATE Initial publication date: February 25, 2025. ARTICLE REFERENCED Deep A, Alexander EC, Brierley J, Damian M, Gupta A, McLin V, Sarma MS, Squires JE, Wildhaber BE. Paediatric acute liver failure: a multidisciplinary perspective on when a critically ill child is unsuitable for liver transplantation. Lancet Child Adolesc Health. 2024 Dec;8(12):921-932. doi: 10.1016/S2352-4642(24)00255-4. TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/at/kn5r4s2wrnh3pm24gb9hkpvk/022025_WSP_Deep_Transplant_Challenges_in_Pediatric_Liver_Failure_Transcript.pdf Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Deep A, Squires J, Wildhaber BE, Burns JP. Transplant Challenges in Pediatric Liver Failure. 02/2025. OPENPediatrics. Online Podcast: https://soundcloud.com/openpediatrics/transplant-challenges-in-pediatric-liver-failure-by-a-deep-et-al-openpediatrics.