Technique and results of cardiac transplantation using "domino-donor" hearts

Heart-lung transplantation is now well established for treatment of patients with terminal cardiopulmonary disease. More than 50% of heart-lung transplant recipients have normal or near normal hearts, with the majority having some degree of right ventricular hypertrophy. This potential source of "prepared" cardiac allografts remained untapped until the introduction of the "domino-donor" operation, a procedure in which the heart-lung recipient serves as a cardiac donor. The implantation of these available allografts contributes to the alleviation of the short supply of donor organs for cardiac transplantation. Aspects of the surgical technique, results, and potential benefits of this procedure are presented.