Mayo Clinic Performs First 'Domino' Transplant in Arizona; Rare Procedure Saves Two Lives at Once, Optimizing Organ Supply

Tuesday, January 28, 2003

Phoenix - Jan. 28, 2003 - Two Phoenix area men are recuperating well at Mayo Clinic Hospital following the first-ever "domino" transplant done in Arizona, a creative way to optimize the limited supply of available organs. A domino transplant is one in which a liver is removed from one patient and immediately transplanted into a second patient. The first patient receives a new liver from another source, in this case, a cadaveric donor.

The domino procedure provides one solution to the "Wait or Innovate" dilemma, in which two patients in need of a liver transplant are able to be transplanted sooner, rather than waiting on the list for a liver that may come in too late. Named "domino" because of the three, sequential surgical procedures, the delicate operations are rare enough that only18 were reportedly done in the U.S. in 2002.

WHO: The first patient, James Cashman, 43, Phoenix, suffers from familial amyloidotic polyneuropathy (FAP), a genetic, degenerative condition in which the liver produces an abnormal protein that causes neurological, coronary and gastrointestinal damage. He donated his liver to Robert Espinoza, 64, of Gilbert, who suffers from primary sclerosing cholangitis (PSC), a disease that attacks the bile ducts of the liver. In both cases, there is no cure and both men were in serious need of a transplant to survive.

WHAT: The first-ever domino transplant in Arizona.

WHEN: The domino transplants began early on the morning of Wednesday, Jan. 22, and continued late into that night.

WHERE: Mayo Clinic Hospital, 5777 E. Mayo Boulevard, Northeast Phoenix.

HOW: The three procedures began with procurement of a cadaveric organ that was transplanted into Cashman. Cashman's liver, in turn, was then transplanted into Espinoza. The good news is that Cashman's liver, once removed from his body, functions normally and will not exhibit symptoms of FAP for 20 to 30 years. Espinoza, the second patient, is expected to live for at least the next two or more decades without experiencing problems from the disease.

WHY: A domino transplant expands the pool of liver donors, being that two patients ultimately benefit from one cadaveric liver. The United Network for Organ Sharing (UNOS) reports that 80,800 candidates are on waiting lists for organs in the U.S. Each day, 16 people die waiting.

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