Dec. 19, 2025
A triple solid organ transplant includes three organs from the same donor — some combination of lung, heart, liver, kidney and pancreas — implanted simultaneously. Surgeons at Mayo Clinic in Arizona have performed the state's and the program's second heart, liver and kidney transplant, offering a treatment for patients with multiorgan failure who otherwise might not have options.
Finding the right fit for multiorgan transplant
Multiorgan transplants, especially triple transplants, remain rare. U.S. medical centers, including all three Mayo Clinic campuses — Arizona, Florida and Minnesota — have performed 62 heart, liver and kidney transplants since 1989, says Bashar A. Aqel, M.D., a transplant hepatologist and chair of the Transplant Center at Mayo Clinic in Phoenix, Arizona. Outside the U.S., few medical centers offer this type of transplant, he says.
Mayo Clinic uses a methodical approach to find the best transplant options for patients, including multiorgan transplant.
"When it comes to multiorgan transplant, we are in problem-solving mode," says D Eric Steidley, M.D., a transplant cardiologist at Mayo Clinic in Phoenix, Arizona, who was part of a multidisciplinary team that completed the triple transplant in May 2025. "Questions run through your mind, such as, 'Can I fix the organs, and will multiple transplants solve the problems we're seeing? And is the rest of the body well enough to get through multiple transplants?' "
In any transplant, there is a need to ensure patients are healthy enough to get a transplant — often a challenge for those who are bedridden or experiencing the severe health issues that lead to the need for transplant. For multiorgan transplant, those needs expand. Nutritional status, fitness, social support and, as Dr. Steidley describes it, grit all have to be strong for patients to have a successful triple transplant.
Dr. Aqel indicates that triple transplant provides hope for life rather than acceptance of death from the diseases involved.
"Patients who need triple transplants have limited options," says Dr. Aqel. "In the absence of the transplant option, the prognosis is extremely poor and the odds of surviving the disease processes are slim to none."
Thus, patients who receive triple transplants feel grateful for an attempt to lengthen their lives, and they knowingly undertake the attendant risks.
"These patients will go through many weeks in the hospital," Dr. Steidley says. "They have to have the physical, emotional and social support necessary so they won't give up. One of the benefits of being in a major transplant program is seeing enough patients to have a good idea of whether they will be successful."
Dr. Aqel explains that a triple transplant necessitates carefully informing the patient about risks and benefits, including the higher risk of a triple transplant compared with that of a single or double transplant. With triple transplant, healthcare professionals closely monitor patients for serious complications such as bleeding, opportunistic infection and adverse effects related to an intensive immunosuppression regimen. The experience of the medical and surgical teams involved with these transplants allows team members to identify these complications early and address them promptly to achieve success with a complex procedure.
Tight coordination among a multidisciplinary team
The triple transplant team that operated in May was sizable and included multiple surgeons and team members operating concurrently:
- Allied health staff.
- Anesthesiologists.
- Heart transplant surgeons.
- Kidney transplant surgeons.
- Liver transplant surgeons.
- Procurement specialists.
During the procedure, which takes around 14 hours to complete, the cardiothoracic team completed the heart transplant first. Liver transplant surgeons then extended the liver incision while keeping the chest open. After completing the transplant, they ensured the new liver was working before closing the chest. The kidney transplant was completed later that day once the patient had stabilized.
In combined heart-liver transplants, there is a delicate balance of making sure the new liver works well enough to provide clotting factors that are crucial after a heart transplant. That's why one common disqualification for heart surgery is liver failure since patients with this condition are prone to bleeding.
"Our goal is to complete the heart transplant without the patient bleeding and get the heart working well enough so when the liver is put in, it gets enough blood to function at a high enough level," Dr. Steidley says. "There is a lot of choreography, and each surgeon has to be in sync with the next one."
This careful choreography begins well before patients enter the operating room. Coordination starts with the entire transplant team being on the same floor of the building, which Dr. Steidley suggests helps build synergy because surgeons can discuss patient surgeries informally on the floor. Surgeons also attend multidisciplinary selection conferences, for example, heart transplant surgeons go to liver transplant discussions.
Ensuring positive transplant outcomes
One of the challenges in organ transplantation is prioritizing giving the organs to the sickest people first but recognizing there is a line between being sick enough to be prioritized and being too sick to receive a transplant.
"With multiorgan transplant, we have challenges when patients' issues begin spiraling," Dr. Steidley says. "Since there are multiple weak links, problems can be more detrimental than for single-organ transplant. One of the differentiators of our transplant team is keeping patients healthy while they wait for their transplant and coordinating their care afterward to make sure they stay healthy."
Mayo Clinic continues to conduct research in multiorgan transplant to ensure positive outcomes as surgeons across the country perform more of these procedures.
"For multiorgan transplants, we are just now collecting data on outcomes of these patients at a national level," Dr. Steidley says. "Up until now, we didn't have standard expectations in terms of survival. Now we are tracking and reporting publicly. We're committed that if we perform these complex transplants, we have to do them with a high success rate."
With successful triple transplants under the team's belt, and with a track record of positive outcomes for double-organ transplants, Dr. Steidley encourages physicians to seek second opinions and ask questions about patients with multiorgan failure.
"If you have a patient who might be a candidate for multiorgan transplant, don't be afraid to call and ask questions or discuss the situation," Dr. Aqel says. "Stay open-minded — we have the multidisciplinary approach and capabilities to offer hope for serious or complex cases."
For more information
Refer a patient to Mayo Clinic.