"Domino" Transplants: One Organ Saving Multiple Lives

The shortage of donor organs in the US is severely low, with more than 103,000 people currently waiting for life-saving transplants, and that’s just one snapshot of a constantly growing list. Every day, about 13 people die because a suitable organ never becomes available, showing the desperate need for new solutions in transplantation (United Network of Organ Sharing). Many patients remain on the waiting list for months or even years, but that list isn’t fully equal. Compatibility requirements for blood type, tissue match, size, urgency, and geographic proximity are rigid, and only a small fraction of organ matches occur quickly enough to save every life. Other factors like medical urgency, length of time on the list, and donor-recipient distance also play crucial roles, meaning that a long waiting list often translates directly into lives lost.

A “domino transplant” is an innovative method in which one transplant recipient, usually a child, receives an organ (heart or liver) and then donates parts of their old organ to one or more other patients. In heart surgery, this strategy is often called a “domino heart valve transplant.” For example, a pediatric patient with end-stage heart disease might undergo a heart transplant and then become a donor for their healthy heart valves, which can be used in other children needing valve replacements. These valves can grow along with the new recipient, something neither mechanical nor xenograft replacements can do, and they drastically reduce the number of reparations a child might have to endure. Surgeons carefully assess size, function, and compatibility to make sure the valves properly fit the anatomy of the recipient before proceeding.

The domino approach makes transplantation significantly more efficient, eliminating wasted organs and expanding donor availability. Instead of one heart saving one patient, a single procedure can benefit two or three patients simultaneously. This not only reduces wait times and saves lives but also emphasizes the principle of organ stewardship, using every possible part of a donated organ to its fullest potential. As long as strict compatibility criteria (like blood type, valve size, and growth potential) are met, recipients can receive tissues that function well and continue to grow naturally. This is a crucial development for pediatric patients in particular, and those who receive living tissue rarely face the need for additional surgeries, and medical teams gain precious time to find newer donors for remaining patients.

Domino transplantation represents a major leap forward in the field of organ transplantation. By turning valves or other parts into lifesaving replacements for additional recipients, this approach prioritizes maximizing every donation, reducing surgical burdens, and demonstrating the creativity in medical science.

Written by Nathan Clemente at Incisionary

References

From NYP’s Health Matters – One Heart Saves Three Lives: Innovative Partial Heart Transplant Performed at Columbia/NYP | Columbia Surgery. (2023). Columbiasurgery.org. https://columbiasurgery.org/news/nyps-health-matters-one-heart-saves-three-lives-innovative-partial-heart-transplant-performed?utm_source

Innovative Split-Root Domino Partial Heart Transplant Saves Three Pediatric Patients With One Donor Heart | Case Study | Advances in Pediatric Cardiology and Transplantation | NewYork-Presbyterian. (2025). NewYork-Presbyterian. https://www.nyp.org/advances/article/pediatric-cardiology/innovative-split-root-domino-partial-heart-transplant-saves-three-pediatric-patients-with-one-donor-heart?utm_source

Organ Donation Statistics | organdonor.gov. (2025, March 4). Organdonor.gov. https://www.organdonor.gov/learn/organ-donation-statistics?utm_source

Organ Transplant | US Organ Donation System | UNOS. (2025, July 29). UNOS. https://unos.org/transplant/?utm_source