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

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.