Published in NewYork-Presbyterian's Health Matters, August 20, 2025
Story by Camille Bautista-Fryer
Transplant surgeons from NewYork-Presbyterian/Columbia University Irving Medical Center successfully performed the first reported living donor domino split-liver transplant in adults in the United States, where one altruistic donor helped save the lives of three patients. The procedure marked a major milestone in helping advance the field of transplant by combining three complex transplant techniques and expanding the donor pool for recipients in need.
On July 8, 2025, in the rare procedure involving four patients, an altruistic living donor donated a portion of their liver to the first recipient, whose original liver, which did not work properly for them because of a metabolic disorder but otherwise functioned normally, was then split and transplanted into two other recipients.
A “domino” transplant refers to a procedure where the recipient of a new organ also becomes an organ donor. Only four domino liver transplants were performed in the United States in 2024, according to the Organ Procurement & Transplantation Network.
“This advancement is a testament to the talented team at NewYork-Presbyterian, our experience in the field, and our commitment to finding innovative ways to increase the chances of patients getting a liver transplant and improving outcomes for both donors and recipients,” says Dr. Tomoaki Kato, chief of transplant surgery at NewYork-Presbyterian/Columbia University Irving Medical Center. “We’re proud to be the first program in the nation to accomplish this kind of surgery with three adult recipients.”
In a total of 15 hours across four operating rooms running concurrently, a surgical team of more than 30 members, including anesthesiologists, nurses, perfusionists, and surgeons, coordinated three separate transplants simultaneously.
“While the day of surgery was the ultimate masterpiece, months of planning went into making this day a success,” says Dr. Alyson Fox, medical director of the Adult Liver Transplant Program at NewYork-Presbyterian/Columbia and hepatologist for three of the patients. One of the best things about working at NewYork-Presbyterian and Columbia is that we have faculty with expertise even in the rarest diseases. We built a multidisciplinary team that included hepatology, transplant surgery, genetics, nutrition, and anesthesia to ensure that every detail leading up to the surgery day was perfect, and the day couldn’t have gone better — the patients are all thriving.”
In a domino liver transplant, a patient with metabolic liver disease, such as a genetic enzyme deficiency, receives a new liver from a donor, then donates their original liver to another patient to set off a chain of transplants. In this case, the initial recipient’s liver was large enough to be divided, or “split,” and transplanted into two different recipients. The procedure is commonly done with pediatric patients due to the sizes of the split liver, but in this instance there were two adult recipients.
Starting at 6:30 a.m., a team led by Dr. Jason Hawksworth, surgical director of adult liver transplantation and chief of hepatobiliary surgery at NewYork-Presbyterian/Columbia, and Dr. Nathaly Llore, transplant surgeon at NewYork-Presbyterian/Columbia, robotically explanted 60 percent of the living donor’s liver and delivered the liver graft to the operating room next door, where a team led by Dr. Kato split the liver in two as they removed the recipient’s liver, and implanted the living donor liver graft.
In two other neighboring operating rooms, Dr. Jean Emond, vice chair of surgery at NewYork-Presbyterian/Columbia, and Dr. Peter Liou, transplant surgeon at NewYork-Presbyterian/Columbia, and their teams removed the diseased livers from their respective patients, and transplanted the liver grafts that Dr. Kato’s team split. Dr. Benjamin Samstein, chief of liver transplantation and hepatobiliary surgery in the Department of Surgery at NewYork-Presbyterian/Weill Cornell Medical Center, and Dr. Juan Rocca, surgical director for the NewYork-Presbyterian and Weill Cornell Medicine Liver Cancer Program, joined the team.
The liver can regenerate, so the donated liver portions will regrow into full size in the next few months. The single donation will result in four full, functioning livers.
“This domino split-liver transplant was unique because it was initiated with the gift of life from an altruistic living donor, whose operation was performed robotically,” says Dr. Hawksworth. “These four operations took a lot of coordination and communication, with months of extensive, logistical planning from a fantastic team to make it happen.”
“Our team recognized our potential to help multiple patients with this one person’s gift,” says Dr. Llore. “It was a privilege to work with an expert team to turn this unprecedented surgical undertaking into a reality to move the field of transplant forward.”
NewYork-Presbyterian offers robotic donor surgery to all living liver donors. The minimally invasive approach with smaller incisions allows living donors a faster recovery.
“This great achievement builds on decades of work, establishing the surgical principles and designing the procedures,” says Dr. Emond. “It could not have been carried out without the talented team and the training traditions that have been assembled here at NewYork-Presbyterian/Columbia.”
“When patients need a liver transplant, we do everything we can to help them, and that often means thinking outside of the box,” Dr. Fox says. “This is the kind of endeavor that you will only find at a place like NewYork-Presbyterian/Columbia. We have the talent and tools to take on the most medically complex patients and perform the most innovative surgeries. We had tremendous support to make this come to fruition, and it was a massive success.”
Related:
- Bots for Tots: The First Program in the U.S. for Robotic Liver Surgery in Children
- Changing the Future of Living Liver Donation: A Conversation about Columbia’s All-Robotic Approach
- Caracas to Santo Domingo: Creating Access to Pediatric Liver Transplant from the Ground, Up