Living donors continue to be rare in the United States, but there's a more exclusive population of donors who take on great risk for the reward of helping a family member, or even a stranger, Sumathi Reddy reports for the Wall Street Journal.

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The people who donated their organs two times

According to the United Network for Organ Sharing (UNOS), in the last 25 years, only 47 people in the United States have donated more than one of their organs to two different people. Of those 47 donors, 43 of them donated a kidney and part of their liver.

Writing for the Wall Street Journal, Reddy profiles three people who have donated organs twice. 

Ephraim Simon

One of these donors is Ephraim Simon, a 51-year-old rabbi from Teaneck, New Jersey. Simon first donated a kidney to a man in 2009 at Weill Cornell Medical Center. After the operation, Simon and the donor recipient became close. Simon called the experience "incredible … I thought I really want to do this again, but I only have one kidney. What can I do?"

When Simon learned about living liver donations, he tried to donate again but had trouble finding a hospital that was willing to let him donate a second organ.

Simon finally found a match at Cleveland Clinic where doctors transplanted part of Simon's liver to a different man last December.

Simon needed more time to recover after the second operation, but he said it was worth it to be able to donate an organ for the second time. "The reward of bringing a father back to his children, of a husband back to his wife, that reward is infinitely greater than any risk that I took," he said. "If I could do this again I would do it tomorrow morning," he said.

Nathan Hauser

Nathan Hauser also donated organs two different times to two different people, but unlike Simon, he's never met the recipients, Reddy reports.

Hauser, a 39-year-old director at a consulting firm in Maryland, became interested in donating his kidney after seeing a commercial about the lack of living kidney donors.

Wanting to remain anonymous, Hauser donated his kidney without a recipient in 2008, which set off a chain of transplants. "I thought it would be more powerful to be anonymous," Hauser said.

Then in 2013, Hauser looked into donating part of his liver. Like Simon, Hauser had trouble finding a hospital that would allow him to donate again, but in 2018, Hauser discovered that the University of Pittsburgh Medical Center was seeking living liver donors. In March, Hauser donated part of his liver to a female recipient and again chose to remain anonymous.

Now, Hauser regularly donates blood and is on the bone marrow registry. "It's a fulfilling way to keep myself busy," he said.

Sean Gomes

For Sean Gomes, 54, both of his organ donations went to family members. In 2003, the information technology manager and high school football coach from California donated a kidney to his father-in-law who was in renal failure.

Then in 2017, Gomes' cousin learned that he needed a liver transplant. Ten months later, Gomes began the process of becoming a living donor and underwent surgery at the University of California, San Francisco in January 2019. Gomes' cousin had some complications after the surgery, but Gomes said he feels "blessed" that he could "help him see his grandson grow up."

Gomes and his wife now donate blood and platelets regularly. Gomes said he would consider becoming a bone marrow donor "if I match someone."

How do you know if someone should donate a second time?

When a potential donor expresses interest in donating an organ—for the first or the second time—they are evaluated by a social worker and sometimes a psychologist or psychiatrist before being cleared for the operation, Reddy reports.

Mary Amanda Dew, a psychiatry professor at the University of Pittsburgh School of Medicine who studies the mental health of organ recipients and donors, said that most organ donors have donated blood or platelets or have demonstrated an interest in community service. If the potential donor doesn't have this history, Dew said the doctors may start to wonder if the donors understand the risks.

When it comes to second-time donors, the social workers inform the potential donors that the outcomes, risks, and recovery for the surgery may be different from their original experience.

And in the case that a person's donation is going to a stranger, the social worker might do a more thorough evaluation of the reasons for their decision.

That said, now that the risks of kidney transplants have decreased, hospitals are more likely to accept donations that go to strangers, according to UNOS Living Donor Committee Chair Randolph Schaffer