title: The "domino-donor" operation in heart and lung transplantation.
abstract: OBJECTIVE
  To report the first "domino-donor" operation performed in Australia; review the results of the first five combined procedures at the Alfred Hospital; and discuss the advantages of the procedure and its place in transplantation.
  
  
  METHODS
  The first domino-donor was a 25-year-old man with cystic fibrosis and pulmonary hypertension, receiving a heart-lung transplant, whose heart was transplanted into a 20-year-old woman with end-stage cardiomyopathy. The cardiac recipient's initial course was satisfactory, but at eight months she developed severe rejection, with failure of the donor heart, and required retransplantation. Subsequently four further combined procedures were performed. All 10 patients are alive and well. Four patients have had cytomegalovirus infection but without major complications. Improved function of the donor right ventricle has been observed when the ventricle is working against a lower resistance.
  
  
  CONCLUSIONS
  Four advantages of the domino procedure are evident: an increased pool of donor allografts; the use of a heart with an hypertrophied ("prepared") right ventricle; absence of the adverse effects of brain-death in the live donor; and improved ability to match the donor and recipient before the operation.
authors.affiliation: Heart and Heart/Lung Replacement Services, Alfred Hospital, Prahran, VIC.
authors.forename: A D
authors.initials: AD
authors.lastname: Cochrane
authors.forename: J A
authors.initials: JA
authors.lastname: Smith
authors.forename: D S
authors.initials: DS
authors.lastname: Esmore
mesh_terms: D000328:Adult; D001315:Australia; D001926:Brain Death / Q000503:physiopathology; D003550:Cystic Fibrosis / Q000601:surgery*; D004992:Ethics, Medical; D005069:Evaluation Studies as Topic; D005260:Female; D006084:Graft Rejection; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D016041:Heart-Lung Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy; D012086:Reoperation; D009927:Tissue and Organ Procurement / Q000379:methods*