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Landscape of Living Multiorgan Donation in the United States

A Registry-Based Cohort Study

Henderson, Macey L., JD, PhD1,2; DiBrito, Sandra R., MD1; Thomas, Alvin G., MSPH1; Holscher, Courtenay M., MD1; Shaffer, Ashton A., BA1,3; Bowring, Mary Grace, MPH1; Purnell, Tanjala S., PhD, MPH1,2; Massie, Allan B., PhD, MHS1,3; Garonzik-Wang, Jacqueline M., MD, PhD1; Waldram, Madeleine M., BS1; Lentine, Krista L., MD, PhD4; Segev, Dorry L., MD, PhD1,3

doi: 10.1097/TP.0000000000002082
Original Clinical Science—General
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Background The donation of multiple allografts from a single living donor is a rare practice, and the patient characteristics and outcomes associated with these procedures are not well described.

Methods Using the Scientific Registry of Transplant Recipients, we identified 101 living multiorgan donors and their 133 recipients.

Results The 49 sequential (donations during separate procedures) multiorgan donors provided grafts to 81 recipients: 21 kidney-then-liver, 15 liver-then-kidney, 5 lung-then-kidney, 3 liver-then-intestine, 3 kidney-then-pancreas, 1 lung-then-liver, and 1 pancreas-then-kidney. Of these donors, 38% donated 2 grafts to the same recipient and 15% donated 2 grafts as non-directed donors. Compared to recipients from first-time, single organ living donors, recipients from second-time living donors had similar graft and patient survival. The 52 simultaneous (multiple donations during one procedure) multiorgan donors provided 2 grafts to 1 recipient each: 48 kidney-pancreas and 4 liver-intestine. Donors had median of 13.4 years (interquartile range, 8.3-18.5 years) of follow-up. There was one reported death of a sequential donor (2.5 years after second donation). Few postdonation complications were reported over a median of 116 days (interquartile range, 0-295 days) of follow-up; however, routine living donor follow-up data were sparse. Recipients of kidneys from second-time living donors had similar graft (P = 0.2) and patient survival (P = 0.4) when compared with recipients from first-time living donors. Similarly, recipients of livers from second-time living donors had similar graft survival (P = 0.9) and patient survival (P = 0.7) when compared with recipients from first-time living donors.

Conclusions Careful documentation of outcomes is needed to ensure ethical practices in selection, informed consent, and postdonation care of this unique donor community.

The authors used SRTR data to characterize living donors who donated more than 1 organ either simultaneously or sequentially. One hundred one cases were identified over the past 2 decades, mostly performed in a small number of centers. One donor died 2.5 years after the second donation but the cause was not recorded and overall, complete follow-up was available for none of the patients. These data are not sufficient to draw conclusions about the value of these procedures.

1 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.

2 Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD.

3 Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.

4 Center for Abdominal Transplantation, St. Louis University School of Medicine, St. Louis, MO.

Received 29 September 2017. Revision received 7 November 2017.

Accepted 26 November 2017.

Funding for this study was provided by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant numbers K01DK114388-01 (PI: Henderson), F32DK105600 (PI: DiBrito), 4R01DK096008-04 (PI: Segev), 5K01DK101677-02 (PI: Massie), and 5K24DK101828-03 (PI: Segev), 1F32DK109662-01 (PI: Holscher), F30DK116658-01 (PI: Shaffer), and by the Agency for Healthcare Research and Quality (AHRQ) grant number K01HS024600 (PI: Purnell).

The authors declare no conflicts of interest.

M.L.H., S.R.D. contributed equally to this article.

M.L.H. participated in research design, writing of the article, and performance of the research. S.D.R. participated in research design, writing of the article, and performance of the research. A.G.T. participated in research design, writing of the article, and data analysis. C.M.H. participated in performance of the research and writing of the article. A.A.S. participated in data analysis and writing of the article. M.G.B. participated in data analysis and writing of the article. T.S.P. participated in the writing of the article and performance of the research. A.B.M. participated in the research design and data analysis. J.G.W. participated in the research design and writing of the article. M.M.W. participated in writing of the article. K.L.L. participated in writing of the article and performance of the research. D.L.S. participated in the performance of the research and oversaw the project.

Correspondence: Macey L. Henderson, JD, PhD, Department of Surgery, Johns Hopkins School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205. (macey@jhmi.edu).

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

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