Dual-Organ Living Donation: How Cleveland Clinic Makes It Work

[Clark]

https://consultqd.clevelandclinic.org/dual-organ-living-donation-how-cleveland-clinic-makes-it-work

Dual-Organ Living Donation: How Cleveland Clinic Makes It Work

Minimally invasive approach, peri- and postoperative protocols reduce risk and recovery time for these rare, magnanimous two-time donors

[/size]They’re known in the medical literature as extreme living donors — people who have given two solid organs, either simultaneously or sequentially, to a transplant recipient or recipients. That’s the technical term. Transplant surgeon C. H. David Kwon, MD, PhD, offers a more lyrical description.“I call them people with a golden heart,” says Dr. Kwon, Cleveland Clinic’s Director of Minimally Invasive Liver Surgery. “They have a different attitude toward life and toward giving. They feel really happy to have helped someone. The action of giving gives back to the person who gives.” Dual-organ living donation — usually involving a kidney and a liver segment or a kidney and distal pancreas — increases the availability of a scarce resource, reducing wait times for transplant recipients (often pediatric patients) and potentially saving more lives. But dual-organ donation remains exceptionally rare, due to the small number of people willing to undergo the demanding procurement procedure twice and transplant programs’ mandate to minimize donor risks. A 2022 study using national transplant data identified 146 dual-organ living donors in the United States since 1994 — less than one-tenth of one percent of all transplants involving living donors during those 18 years.

[/size]Cleveland Clinic’s extensive experience in transplantation and expertise in minimally invasive surgery, which reduces donors’ postoperative pain and expedites recovery, facilitates dual-organ living donation. Since 2012, 22 dual-organ living donors have had one or both of their procurement surgeries at Cleveland Clinic.[/color]

[/size]“We have one of the largest series in the U.S. that I know of,” Dr. Kwon says. “Altruistic donors come to us because we do minimally invasive surgery and because of our surgical expertise in utilizing the [smaller] left lobe of the liver.”Left-lobe hemihepatectomy is safer for donors because it preserves a larger functional remnant but requires vigilant postoperative management of recipients due to the smaller graft size.

[/size]Cleveland Clinic has provided fully laparoscopic living donor hemihepatectomy for transplantation since 2019 with the arrival of Dr. Kwon, one of the world’s most experienced laparoscopic living donor liver surgeons. The living donor liver transplant program under the direction of Koji Hashimoto, MD, PhD, has developed and demonstrated the efficacy of surgical modifications that lower the threshold for using small grafts, especially left-lobe grafts, without compromising organ functionality or transplant outcomes.

[/size]“Cleveland Clinic has been pioneering in this field, particularly in the minimally invasive approach for living donor surgery,” says pediatric gastroenterologist and hepatologist Kadakkal Radhakrishnan, MD. “That’s an area that needs expertise.”

[/size]“We have observed, especially after we started our laparoscopic living donor program, that previous altruistic kidney donors want to donate a portion of their liver now,” Dr. Kwon says. “And previous liver donors want to donate a kidney. It goes both ways.”[/color]
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