Transplant Articles from Ochsner Health Experts

Elevating Living Donor Kidney Transplantation with Dennis Sonnier, MD

Ochsner Health has a long history of performing kidney transplants, having completed more than 3,500 kidney and kidney-pancreas transplants since 1973. After more than 50 years, the kidney transplant program, part of the Ochsner Transplant Institute, continues evolving and excelling. In 2025, the program received the prestigious ELITE status from INTERLINK COE Networks & Programs, a sign of high-quality results and exceptional care. 

Much of the innovation in the kidney transplant program involves living donations, which comprise approximately 30% of kidney transplants at Ochsner. Living donation is a critical tool in the face of a shortfall of deceased donor kidneys. For patients on or nearing dialysis, a living donor kidney provides a solution that can be implemented quickly and has the potential to endure for years. 

“Most patients would likely wait on the deceased donor list a long time, and their condition could worsen over that period,” said Dennis Sonnier, MD, a transplant surgeon and surgical director of kidney transplant at Ochsner Medical Center - New Orleans, and surgical clerkship director for the University of Queensland-Ochsner Clinical School Program. “On the other hand, a living donor transplant can take place within weeks, allowing patients to discontinue or avoid dialysis, and eliminate the risk of never getting a transplant.” 

Adding Detail to Donor Evaluations

A passionate advocate for living kidney donation, Dr. Sonnier has helped streamline the process for donors and recipients in numerous ways, including introducing 3D visualization to donor evaluation. 

Every prospective donor receives a high-quality, multiphase, contrast-enhanced CT scan to help the transplant surgeon understand their anatomy and choose the optimal surgical approach. Anatomical variations, such as multiple arteries or veins serving a kidney, can complicate surgical planning. When that’s the case, Dr. Sonnier partners with neurological rehabilitation specialist Korak Sarkar, MD, MHDS, FAAN, and the Ochsner BioDesign Lab to create a virtual reality model of the organ for enhanced visualization. 

“Having 3D visualization in the form of a VR model helps the surgeon and the rest of the team understand the structure of the arteries, veins and kidneys, which allows us to make the best decisions for both donor and recipient,” Dr. Sonnier said. “In addition, the model is a useful communications tool because the entire team can look at a monitor together and see the same thing. Otherwise, we might look at different parts of the CT images or interpret them differently.” 

Robotic Surgery’s Next Step 

Around 15 years ago, Ochsner transplant surgeons began performing minimally invasive robotic living donor nephrectomies. Robotic technology, Dr. Sonnier said, allows patients to donate their kidneys with minimal pain and a speedy recovery. Now, living donor recipients can also enjoy the benefits of robotic surgery. 

“In 2025, we started performing robotic minimally invasive transplant procedures for recipients as well as robotic nephrectomies for donors,” Dr. Sonnier said. “The recipient operation involves a lot of complex suturing and positioning. As the field of minimally invasive surgery has grown, so has our comfort with using the robot. That, in turn, allowed us to refine the techniques to offer robotic recipient surgery. The technical aspects of the two procedures are quite different for the surgeon. Donors and recipients, though, enjoy similar benefits, including small incisions, fewer wound complications and a quick recovery.” 

Honing High-Stakes Surgical Skills 

To build proficiency in performing robotic transplant surgery for recipients, Dr. Sonnier turned to another product of collaboration with the BioDesign Lab: a 3D-printed kidney transplant simulator. A box-like reproduction of the surgical field, the simulator features a replica kidney and latex tubes that mimic the associated vasculature. 

Dr. Sonnier honed his robotic surgery skills by practicing on the simulator with the robot. Medical trainees also use the simulator to practice sewing blood vessels from the donor kidney to those of the recipient’s abdomen. 

“Many residents come to our service without experience in kidney transplantation, but they have to assist us in the operations and perform critical, time-sensitive steps,” Dr. Sonnier said. “Allowing trainees to practice on the simulator on their own time or with us in the simulation lab enhances their learning and, in turn, patient care.” 

Groundbreaking Achievement 

Ochsner transplant surgeons’ commitment to pushing the field forward has yielded notable accomplishments, including Louisiana’s first international paired kidney donation. 

The 2022 transplant saw a 19-year-old Louisiana woman with polycystic kidney disease receive a kidney from a Danish woman. The latter wasn’t a match for her husband, who also needed a kidney transplant, but enrolling in an international registry yielded the new kidney he needed. The registry required his wife to enroll as a living donor, which led to the match with the Louisiana patient. 

“This case was an interesting opportunity that occurred through our partnership with the Alliance for Paired Kidney Donation,” Dr. Sonnier said. “We work with the organization to facilitate live donor transplants in our patients who have a live donor, but the two aren’t compatible. The Alliance finds a match with a donor/recipient pair at another center who are also incompatible. The organization’s algorithm identifies a match between our donor and their recipient, and their donor and our recipient.” 

For Dr. Sonnier, the 2022 case speaks not only to the kidney transplant program’s close partnership with the Alliance but also to the team’s commitment to pursuing any opportunity that may help a patient get a transplant. 

Passionate Advocate for Living Donation 

Increasing living kidney donation at Ochsner even further, Dr. Sonnier said, requires educating patients at multiple touchpoints. 

“We have to reach patients where they are and help them understand the need for a living donor,” he said. “We educate patients about what it means to be on the wait-list for a deceased donor organ and the potential consequences of that, which helps them understand the benefits of live donation. We emphasize the safety of a loved one potentially donating a kidney to them. Living donation is at the forefront of everyone’s mind in our transplant division.” 

Referring physicians are key in taking living kidney donation to the next level. 

“If a primary care physician or another clinician has a patient with kidney failure, I hope they would encourage them to find a live donor,” Dr. Sonnier said. “Advise them to talk to their family, friends or contacts at school, work or in their faith community, whatever they can do to advocate for living donation.” 

How to Refer

To refer a patient or learn more about the kidney transplant program, email kidneytransplant@ochsner.org or call 504-842-3925.

Living Donor Liver Transplantation Reaches New Heights

Ochsner Health’s Ochsner Transplant Institute has long been one of the premier liver transplant centers in the U.S. Once the national leader in liver transplant volumes, Ochsner has performed more than 3,000 surgeries, including Louisiana’s first, since 1984.

The liver transplant program is building on this legacy by quadrupling its living donor liver transplants over the past three years, increasing from one every other year to as many as 10-plus annually. John Seal, MD, surgical director of the living donor liver transplant program and pediatric liver transplant program, has helped drive the increase.

Swift pivot to transplant surgery

As a young physician interested in pediatric surgery, Dr. Seal viewed transplant surgery as “very esoteric and almost unattainable.” That changed during his residency at the University of Chicago Medical Center in the late 2000s and early 2010s. The medical center was the site of the first successful living donor liver transplant in the U.S. in 1989.

“I rotated onto the transplant surgery service and received real exposure to what it was all about,” Dr. Seal said. “It was an exciting time, with exciting people doing transplant surgery. I had some important mentors during that period, and I pivoted from pediatric surgery to transplant surgery pretty quickly.”

Ensuring donor safety

Donor safety is of paramount importance in living donor liver transplantation because, as Dr. Seal pointed out, donors do not derive a physiologic benefit from the surgery. To ensure high safety standards and eliminate bias, the Ochsner living donor liver transplant program features separate teams for donor evaluation and recipient management and surgery. The donor evaluation process includes:

• A general health assessment by an internal medicine physician
• A liver health assessment (with a focus on the donor’s risk of developing fatty liver disease and other liver conditions later in life) by a hepatologist
• Image-based mapping of the liver’s bile ducts and blood vessels, and the creation of a 3D liver model (used to plan complex cases in virtual reality simulations) in partnership with the Ochsner BioDesign Lab
• Psychosocial counseling to evaluate donors’ motivations for donating and family support

“I perform the donor operations and am involved with their evaluations to determine whether we can do the surgery safely from a technical standpoint,” Dr. Seal said. “We need to know some fundamental things about the liver anatomy to determine that. First, we must ensure the piece of liver we leave behind in the donor will be at least 30% of the organ’s volume. Second, the portion of the living donor liver must be large enough to meet the recipient's needs, around 0.8% to 1% of their body weight.”

Innovation in open donor surgery

In the future, Dr. Seal envisions robotic surgery becoming part of the living liver donation process, as it has for living donor kidney transplants at Ochsner. First, though, surgeons will need to optimize the safety of robotic liver surgery, which Dr. Seal expects will occur in the years ahead.

“The liver is, essentially, a blood sponge, with many large internal blood vessels,” he said. “We have decades of experience performing the operation through an open approach. We routinely perform liver surgery for cancer and other indications safely. Dividing the liver for the purpose of transplanting the portion that is removed is a much higher technical standard. So, until we perfect the robotic approach for living liver donation, I have to ensure I perform the safest possible surgery for donors and recipients.”

In the meantime, rather than perform the open donor surgery through a large subcostal incision, Dr. Seal has modified the approach. He accesses the liver through a relatively small midline incision stretching from the base of the breastbone to the top of the belly button. This approach does not cut the abdominal muscles, resulting in faster recoveries and minimal scarring.

Handling complex cases 

Most people who need a liver transplant are eligible for living donation, and the Ochsner team can successfully perform living donation surgery on almost any patient. This includes complex recipients with conditions such as morbid obesity or portal vein thrombosis.

“For patients with portal vein thrombosis, we can connect a cannula to the portal vein and bypass the blood back to central circulation,” Dr. Seal said. “That relieves the portal hypertension, decreases congestion in the bowels and takes us off the time clock. Normally, we clamp those vessels and have 30 to 45 minutes to sew the donated liver in. With a bypass in place, we have more time to be meticulous and do the vascular reconstructions without much stress on the recipient.”

Collaborating across specialties & building buy-in

Decades of experience with liver transplantation have allowed Ochsner to develop specialized and integrated cross-specialty collaborations. The living donor liver transplant team works closely with infectious disease specialists, anesthesiologists, interventional radiologists and endoscopists, to name a few.

In what Dr. Seal calls a “sea change” in recent years, hepatologists and other specialists now recognize living donation as the fastest and most reliable path to liver transplantation. Plus, more referring specialists are aware of Ochsner’s ability to transplant practically any patient, leading the living donor liver transplant program to transcend the Model for End-Stage Liver Disease (MELD) score norms for transplant candidacy.

“Historically, a score of 15 [on a 6-to-40 range] was the point at which you have more benefit from a transplant than risk,” Dr. Seal said. “That’s an old figure based on data from the 1990s. Instead of looking for that magic number, we regard anyone with significant symptoms of liver disease, regardless of MELD score, as a candidate for a transplant. That’s a big deal because it allows us to transplant patients earlier in their disease progression and produce better outcomes.”

Overcoming barriers to further growth

Dr. Seal has significant goals for living donor liver transplantation at Ochsner, from enhancing clinician and patient education about living donation to creating a registry of potential living donors for pediatric recipients. To keep growing the program, Dr. Seal and the rest of the team are finding solutions to the challenges facing living liver donation in Louisiana, including donor obesity.

“We’re pushing the boundaries regarding donor weight,” Dr. Seal said. “Many centers won’t select donors with a body mass index greater than 30. We work with donors to lose weight if they’re otherwise healthy. The majority of our donors have had a BMI over 30.”
If a donor isn’t healthy enough to donate, the living donor liver transplant program will empower them to become a donor champion. The team will educate them on identifying potential donors using friend networks, social media and other avenues.

How to Refer

Refer a patient or learn more about the liver transplant program by emailing refliver@ochsner.org or calling 504-842-3925.