Landscape of Living Multi-organ Donation in the United States: A Registry-Based Cohort Study

ABSTRACTBackgroundThe 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.MethodsUsing the SRTR registry, we identified 101 living multi-organ donors and their 133 recipients.ResultsThe 49 sequential (donations during separate procedures) multi-organ 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) multi-organ donors provided 2 grafts to 1 recipient each: 48 kidney-pancreas and 4 liver-intestine. Donors had median (IQR) 13.4 [8.3-18.5] years of follow-up for mortality. There was one reported death of sequential donor (2.5 years after second donation). Few post-donation complications were reported over median (IQR) 116 (0-295) days follow-up; however, routine living donor follow-up data were sparse. Recipients of kidneys from second-time living donors had similar graft (p=0.8) and patient survival (p=0.4) when compared to recipients from first-time living donors. Similarly recipients of livers from second-time living donors had similar graft survival (p=0.8) and patient survival (p=0.7) when compared to recipients from first-time living donors.ConclusionsCareful documentation of outcomes is needed to ensure ethical practices in selection, informed consent, and post-donation care of this unique donor community. 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 SRTR registry, we identified 101 living multi-organ donors and their 133 recipients. Results The 49 sequential (donations during separate procedures) multi-organ 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) multi-organ donors provided 2 grafts to 1 recipient each: 48 kidney-pancreas and 4 liver-intestine. Donors had median (IQR) 13.4 [8.3-18.5] years of follow-up for mortality. There was one reported death of sequential donor (2.5 years after second donation). Few post-donation complications were reported over median (IQR) 116 (0-295) days follow-up; however, routine living donor follow-up data were sparse. Recipients of kidneys from second-time living donors had similar graft (p=0.8) and patient survival (p=0.4) when compared to recipients from first-time living donors. Similarly recipients of livers from second-time living donors had similar graft survival (p=0.8) and patient survival (p=0.7) when compared to recipients from first-time living donors. Conclusions Careful documentation of outcomes is needed to ensure ethical practices in selection, informed consent, and post-donation care of this unique donor community. Contact Information: Macey L. Henderson, JD, PhD, Assistant Professor, Department of Surgery, Johns Hopkins School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205, (443) 287-664 (tel) 410-614-2079 (fax), macey@jhmi.edu AUTHORSHIP M.L.H. participated in research design, writing of the paper, and performance of the research. S.D.R. participated in research design, writing of the paper, and performance of the research. A.G.T. participated in research design, writing of the paper, and data analysis. C.M.H. participated in performance of the research and writing of the paper. A.A.S. participated in data analysis and writing of the paper. M.G.B. participated in data analysis and writing of the paper. T.S.P. participated in the writing of the paper 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 paper. M.M.W. participated in writing of the paper. K.L.L. participated in writing of the paper and performance of the research. D.L.S. participated in the performance of the research and oversaw the project. *MLH and SRD contributed equally to this manuscript Disclosures: The authors have no conflicts of interest to disclose. Funding: 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) and by the Agency for Healthcare Research and Quality (AHRQ) grant number K01HS024600 (PI: Purnell). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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