The domino transplant: transplant recipients as organ donors.

The success of solid organ transplantation is limited by ongoing problems with organ availability. The use of extended cadaveric donors as well as the use of living donors are both strategies used to overcome this shortage. One group of potential donors that has not been previously reported are those who have previously received an organ transplant. This type of transplant was first described as a domino transplantation of heart-lung and heart (1). A combined heart-lung transplant was performed in a patient with end-stage lung disease, but who still had adequate heart performance. The normal heart of this heart-lung recipient was then transplanted into a second patient with end-stage heart disease. In similar types of procedures, the successful retransplantation of a liver allograft from a liver recipient who suffered brain death has been described, as well as retransplantation of a renal allograft (2, 3). The transplantation of kidneys from a heart transplant recipient who suffered brain death has also been reported (4). To obtain a better understanding of the scope and results as such procedures, we performed a comprehensive review of the United States experience (5).