Sequential dual-organ living donation: selection, operative approach, and early donor outcomes at a Canadian center.

Sequential dual-organ living donation, defined as donation of a kidney and a partial liver graft by the same individual in separate operations, represents a rare extension of living donor transplantation. A donor-focused analysis was performed to characterize the donor population, the operative considerations posed by a second donor operation, and early donor outcomes at a single high-volume center. A retrospective review of all dual-organ living donors at our institute was performed. Twenty-four donors were identified (n = 10 liver-first and n = 14 kidney-first). The median interval between donations was 2 years (IQR 1.1-4.2). Twelve donors donated both organs anonymously, nine donated one organ anonymously and directed the other, and three directed both donations. Anonymous donation is a strong motivator in this unique population. Ten donors (42%) participated in kidney paired donation. Liver donations (left lateral segment (42%), left lobe (25%), and right lobe (33%)) were performed by an open approach. Laparoscopic nephrectomy was performed in all cases except two prior liver donors. Liver-after-kidney donors (n = 14) did not develop renal dysfunction after donation. Prior organ donation does not usually require modification of surgical technique for the second procedure. Dual-organ living donation is rare but can be safely performed independent of sequence.