Domino Transplantation

Tuesday, January 28, 2003

One creative way to address the shortage of livers available for transplantation is the rare, yet effective "domino" procedure.

In a domino liver transplant, a liver that needs removing in one patient is transplanted into a second patient who also needs a liver. The first patient receives a cadaveric liver. In some rare instances, a living donor can be used for the first procedure.

In the case of the domino transplant on Jan. 22, 2003, at Mayo Clinic Hospital, a cadaveric liver was transplanted into the first patient. In turn, the liver from the first patient was transplanted into the second patient. In this case, the liver from the first patient, once removed, functions normally and will not exhibit symptoms of disease for 20 or 30 years, allowing the second patient to live a full life for at least two to three decades without experiencing problems from the disease.

In this domino liver transplant, the first patient suffers from familial amyloidotic polyneuropathy (FAP) type 1, a rare disorder in which the liver produces an abnormal protein that damages the heart, neurological system and gastrointestinal tract.

A patient with FAP is, however, a good candidate for a domino transplant that could help another person with liver disease. That is because uniquely with FAP, the liver is anatomically and functionally normal once removed.

Domino transplantation is a way of optimizing the limited organ supply, benefiting "two for one," in effect.

Globally, domino liver transplants have been done only slightly more than 200 times since the procedure was first recorded. According to statistics from the Familial Amyloidotic Polyneuropathy (FAP) World Transplant Register, 18 domino transplants were performed in the U.S. in 2002.

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