Kidney then liver donation?

[Snoopy]

[I know a version of this topic was discussed several months ago, but when I tried to add my post, the system suggested I begin a new thread. So...]

   Has anybody here donated both a kidney and a liver (on separate occasions, of course)?  I'd be interested in hearing from you.  Apparently, it's at least possible, but pretty unusual.
        Be well, Snoopy

[Clark]

So unusual there's no data or studies! We're left with anecdotes from those who've chosen to share them, and they are very, very few. In terms of thinking about it, though, as I've said elsewhere, when my kidney recipient was going through a rough patch trying tho get meds right about two years in, her liver enzymes were spiking. I told her then that should she need a liver transplant as well as the kidney, I'd be the most logical choice medically from her perspective, and that I was fine with being first in line. No need yet.

[Snoopy]

Hi, Clark.
  Thanks for the reply.  I hope your recipient continues not to need to take you up on your very kind offer of a liver donation. 
   Given how carefully the system questions you about donating "even" a kidney during the evaluation process, I would expect they would need some persuading for the same individual to part with another piece of himself.  But I do see your point about one's pre-screened suitability for the same donor.
      Be well, Snoopy

[Michael]

Harry Kiernan is one person I'm aware of. A Google search of his name will get you the story.

[WilliamLFreeman]

Snoopy & y'all,

To my knowledge, there is still only 1 study reported about dual donations.  It was an Abstract of a Poster in the annual American Transplant Congress, late spring 2012.  Abstract of the Poster is below.

Liver-Kidney ‘Double’ Donation by Living Donor Good Samaritans: Kindness or Craziness?
Background: Donating two organs (liver lobe and kidney) during one’s life-time is an act of extreme selflessness. Donor profiles and outcomes after such ‘double’ donations have never been reported before.
Methods: All potential living liver donors evaluated at our center from 1998 to 2010 were studied retrospectively. Donors who had donated both a liver lobe and a kidney were analyzed.
Results: We evaluated 345 potential living liver donors. There were 27 potential Good Samaritan donors and 12/27 donated a liver lobe successfully. There were 5 liver lobe-kidney ‘double’ donors (4/5 Good Samaritans and one directed donation).
Conclusions: All the Good Samaritan living liver-kidney ‘double donors’ at our center were well-educated, successfully employed Caucasians, with previous charitable acts of donation. All donors had excellent surgical and psychological outcomes after donation with return to their previous occupations. Donation of liver lobe-kidney by Good Samaritans, after thorough medical and psychological evaluation, is ethical and is facilitated by the extremely motivated donors themselves.
       SUMMARY OF TABLE in Abstract:
“Outcomes Of Liver Lobe And Kidney Living Donors”
Liver lobe donated:  Right lobe (5/5).
Kidney donated:  Left (5/5).
Operative procedure of kidney donation:  Laparotomy (2/5);  Open (3/5).
Time interval between donations:  4 yrs (1/5); 3 yrs (1/5); 2 yrs (2/5); 5 mo (1/5)
Liver Donation type:  Non-directed (4/5); Directed (1/5)
Age/Sex/Race:  Age range 30-52; Female (3/5), Male (2/5); White (5/5.
Profession:  Info-technology (2/5/); Financial officer or Accountant (2/5); Horse trainer 1/5)
Reason for donation:  Wanted to help (3/5); Coworker died (1/5); To help husband (1/5).
Previous donations:  Blood donor & Bone marrow donor list (2/5); Blood donor only (2/5); No previous donation (1/5).
Hospital stay for liver donation:  6 days (1/5); 5 (4/5).
Complications liver donation:  None (4/5); Cut-surface bile leak (1/5).
Change in serum creatinine from pre-op liver to 1-yr after:  Decreased (4/5); post-op not yet obtained (1/5).
Liver function tests 1-yr post-op:
   AST:  less than 30 (3/5); 42 (1/5); not yet obtained (1/5).
   ALT:  less than 25 (3/5); 36 (1/5); not yet obtained (1/5).
   Bilirubin: less than 0.9 (3/5); 1.1 (1/5); not yet obtained (1/5).
Returned to work after liver donation:  Yes (5/5).
Donor satisfaction after liver donation:  Feels good (3/5); No regrets (2/5).
Recipient outcome:  Alive (3/5) as of 4 yrs, 3 yrs, & 3 mo;  Died (2/5) at 8 yrs & 2 yrs.

My added notes: As I recall, the Poster itself had more information about the mental and emotional health of the five people than the Abstract did.  My impression is that the acceptance by transplant centers of the legitimacy of the idea of dual donations is about where acceptance of the legitimacy of the idea of non-directed donations was about 20 to 25 years ago.  It was a long process of acceptance of non-directed (single-organ) donations back then, starting with just one center, with most centers assuming that EVERYONE with a desire to be a non-directed donor must be crazy -- yes, "crazy," by virtue of that desire. (As I recall, that Brown University was the first report doing a non-directed donation -- only after a long LONG evaluation and discussion -- of am unmarried Buddhist woman whose desire, Brown University concluded, fit her strong Buddhist faith and was not a sign she was "crazy."  Note the title of the Abstract above.)

Editorial comment: some people have difficulty "wrapping their head around" altruism.   

Bill

[Snoopy]

Dear Bill (and Michael and Clark),
   Thanks for all your information.
   Taking another tack, I went elsewhere on LDO and looked at the overview of liver donation.  I noticed two things.
   First, the evaluation process seems to include tests involving injecting contrast dye.  Could that, in itself, be a deal breaker for the one-kidney crowd?
   Second, it seems that a size match with the recipient is a factor.  Does that mean that an adult can't donate to a child?  Since only part of the liver is donated, it hadn't occurred to me that donor and recipient need to be (at least to some extent) size compatible.
           Be well, Snoopy
   

[Clark]

There are alternatives for radiologists to the nephrotoxic contrast dyes, each with their own risk/benefit profiles, and as always you'd have to make that call yourself. Your size question I believe is more an issue the other way, from a smaller donor to a larger recipient.

[Snoopy]

Ah, thanks, Clark, for that speedy, informative reply.  I'll post again if I come across any more substantive info, in case anybody else is curious.
   Be well, Snoopy

[WilliamLFreeman]

RE: age & size differentials in living liver donation,
I will add to Clark's last post.  As I understand it, adult-to-child living liver donation may be safer for the donor than adult-to-adult donation.  The reason is that adult-to-child liver donation usually takes the smaller left lobe of the adult's liver for the small child, a less dangerous operation than taking (part of) the adult's large right lobe of the liver.
Bill

[Michael]

Agreeing with Clark (John) and Bill.

[nameless]

Do we know what transplant centers these NDD used for there liver donation?  Also would having higher cholesterol rule you out from being a donor? Can any of you think of any potential long term risk that could come about from donating a kidney and a small piece of a liver to a child?  Any input would be appreciated!