Liver transplantation (LTx) has developed into an established therapy also in children and adolescents. In pediatric patients, numbers of transplantations, age distribution of patients as well as underlying diseases for LTx have remained constant since many years and there is also no increase to be expected as to the indications for pediatric LTx. Whereas splitting of livers, an established surgical therapy modality to provide two recipients with a new organ, is not performed in all divisable organs, mortality of children waiting for a liver transplant remains a critical topic. Waitlist time of a maximum of 3 months as required by law is largely exceeded. In the medium term, we cannot abstain from a split liver transplant program in order to provide adequate care for terminally ill pediatric liver patients and to optimally use divisable donor organs. Therefore, models of cooperation between centres with and without split organ programs have to be developed and sufficient time, staff and financial resources have to be dedicated to this project.