Aug. 10, 2023
A triple solid organ transplant includes three organs — some combination of lung, heart, liver, kidney, pancreas — from the same donor implanted simultaneously. One of the most common forms of triple solid organ transplant involves a heart, a liver and a kidney, according to Bashar A. Aqel, M.D., a transplant hepatologist and Transplant Center medical director at Mayo Clinic in Arizona.
Rationales for a single donor providing all organs for a multiorgan transplant include facilitating logistics and ensuring the greatest chance of a positive outcome, says Dr. Aqel.
"If someone has multiorgan failure, you can't transplant one organ to that recipient," says Dr. Aqel. "The transplant would have a high failure risk. If individuals needing a heart transplant also have poorly functioning livers and kidneys, they won't make it out of surgery if you perform a heart transplant only."
U.S. medical centers, including all three Mayo Clinic campuses in Arizona, Florida and Minnesota, have performed 46 triple transplants since 1989, says Dr. Aqel. In 2022, U.S. medical centers performed eight triple transplants, including one at Mayo Clinic in Arizona, the first such transplant in the state. Outside the U.S., few medical centers offer this type of transplant, he says.
Medical status and triple transplant eligibility
Transplant specialists place patients in need of triple transplant on the standard transplant waitlist, specifying a requirement for same-donor multiple-organ transplant. Heart or liver disease severity determines triple transplant organ allocation.
Most frequently, a patient's progressing heart disease drives specialists' consideration of triple transplant. Often, advanced-stage heart failure damages an individual's liver and kidneys. The converse also is true: Kidney or liver disease can precipitate heart failure.
Though patient ages vary for triple transplant, eligible patients often are children and young adults. The patient who received a triple transplant at Mayo Clinic in Arizona in December 2022, however, was in his 50s.
"Triple transplant's complexity calls for robust clinical status," says Dr. Aqel. "Selection is crucial, especially as recovery is challenging. You almost need a perfect patient."
He says no formal triple transplant eligibility criteria exist. Determining eligibility is complex, with criteria accompanying each organ the patient will receive. At Mayo Clinic, organ-specific selection committees assess eligibility and consider the disease involved. Each committee makes a recommendation in a joint meeting of all selection committees, putting all expertise together to determine how to proceed.
A triple transplant begins with the heart, if involved, as it is more time sensitive to damage outside the donor body than are the other organs.
Triple transplant benefits and considerations
Dr. Aqel indicates that triple transplant provides hope for life rather than acceptance of death from the disease 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."
"Triple transplant gives patients their lives back and is the ultimate representation of the gift of life."
Thus, patients who receive triple transplants feel grateful for an attempt to lengthen their lives and knowingly undertake the attendant risks.
Dr. Aqel explains that a triple transplant necessitates carefully informing the patient about risks and benefits, including triple transplant's higher risk compared with that of a single or double transplant. Healthcare professionals closely monitor these patients for serious complications such as bleeding, opportunistic infection and adverse effects related to the intensive immunosuppression regimen. The experience of the medical and surgical teams involved with these transplants allows them to identify these complications early and address them promptly to achieve success with such a complex procedure.
The aspiration for a triple transplant is to return patients to their quality of life years before their illnesses, he says.
"They have been bedbound," he says. "After the transplant, they are walking."
Elements necessary for successful triple transplant
With the risks accompanying a triple transplant, depth of expertise across relevant organ systems is crucial for success, explains Dr. Aqel.
"It's hard to coordinate several transplants at once, even for medical centers with a breadth of organ transplant," he says.
A medical center offering triple transplant, such as Mayo Clinic, must have staffing and facilities for a lengthy operation. Surgery for the individual who received a triple transplant at Mayo Clinic in Arizona lasted approximately 14 hours. The surgical team targeted a short-as-possible total OR time to lower risk to the patient and to the organs involved while outside a human body.
Staffing for the Mayo Clinic in Arizona triple transplant required 10 to 15 medical professionals in the OR simultaneously, with additional staff rotating in at regular intervals. Those involved included heart, liver and kidney transplant teams, anesthesia teams, OR nurses, and others.
Triple transplant planning requires tremendous coordination and collaboration, says Dr. Aqel, noting Mayo Clinic is well positioned for this type of care. The three organ transplant teams meet and form a sequence, also called a playbook, for the operation. Planning also includes backup teams in case of unpredictable events and need to extend surgery.
"This kind of a playbook tells you when team A ends and team B starts, eliminating confusion," Dr. Aqel says.
Including selection committee time involved, days of planning are needed prior to a triple transplant, he says.
After a triple transplant is complete, the medical center also must offer recovery services for the individual transplanted.
For more information
Refer a patient to Mayo Clinic.