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Middle-aged female underwent transplantation with her mother as a donor after appropriate desensitization. The patient developed graft dysfunction with systemic features of thrombotic microangiopathy. Renal allograft biopsy was suggestive of antibody-mediated rejection. She was treated with plasmapheresis followed by intravenous immunoglobulin. However, due to lack of response, further workup was sent and the patient was found to have ADAMTS 13 levels <1% with no evidence of antibodies. Hence, she was diagnosed to have congenital thrombotic thrombocytopenic purpura. A graft nephrectomy was done, and the patient was managed with frozen plasma infusions until remission. Currently, the patient is back on maintenance hemodialysis and is doing well and planned for a genetic study. [ABSTRACT FROM AUTHOR]

There is a global shortage of transplantable organs, especially in a resource‑limited country like India. Deceased pediatric donors provide an excellent opportunity to expand the donor pool. Herein, we report a rare case of multi‑organ harvesting from a 3‑year‑old brain‑dead donor, where both the kidneys were transplanted en bloc to an adult male recipient and the liver to a 4‑year‑old male child. This case report provides the surgical steps and our experience. [ABSTRACT FROM AUTHOR]