There are numerous kinds of multivisceral transplant operations: e.g. all of the intra-abdominal organs, liver-duodenum-pancreas, liver-stomach-duodenum-pancreas, liver-intestine and other combinations. All of these procedures are derived from an operation described in dogs in 1960-62 in which the spleen also was part of the full multivisceral allograft. The constituent organs could be construed as grapes on a vascular stem - to be left intact, picked off and discarded, or transplanted separately. When the intestine was included in the allograft, it always has been the Achilles heel of the transplant.