It was during my training in a large transplant center that I was fortunate enough to participate in a relatively rare procedure – the domino liver transplant.
The procedure involves two recipients receiving liver transplants almost simultaneously. A deceased donor liver is used for the first recipient A, who has a rare hereditary disease, in most cases this being a metabolic disease called amyloidosis. This disease is characterized by a build up of abnormal protein called amyloid in various organs of the body, which causes organ failure. This protein is made by the liver from birth but the manifestations of the disease, called amyloidosis, is seen at a much later age, usually when the patient is middle aged. The only treatment for this disease is liver transplantation. The liver that is removed from this recipient A can then be re-used in recipient B, who has liver failure from another cause. Even though the amyloid will continue to be produced in recipient B, it will take a few decades for it to manifest itself, by which time the recipient has usually lived out his life span. In 2008, a study looking at recurrence of the amyloidosis in the recipient found 2 cases out of 500 that had this problem recur.
My colleague and I were picked up very early morning from our hospital and driven to another large hospital in the same city, where we procured the liver from a brain dead donor. Almost simultaneously, recipient A, who had amyloidosis, was taken to the operating room by a second team that removed the liver at our center. Once we arrived back, I went in with the liver we had procured into recipient A’s room and started to help with the transplant procedure. My colleague took the amyloid liver from recipient A to recipient B’s room, where his diseased liver was removed and replaced with the liver from recipient A. By the end of the day, both patients were doing well in the recovery room, their livers working well and both of them well on the road to recovery.
A day that I will never forget when two lives were saved because of the miracle we call transplantation and by the advances made by science and medicine. This kind of bold and progressive thinking has decreased the critical organ shortage we face in the US for people with liver failure, waiting for a transplant. We still have a long way to go and efforts are under way for more advancements in the field of transplantation and immunology.