Figure 38. Early pregnancy loss with twin transfusion after death of the first sibling. Viscera of the above twins. Compare the size of hearts, lungs and kidneys. As stated, the chronic recipient commonly dies of congestive heart failure due to chronic circulatory overload. Restricted lung development in the donor may reflect effects of oligohydramnios (if diamniotic twins) or overall growth restriction. Even kidney size is directly proportional to its functional demands; the kidneys of the chronic donor, with decreased circulatory volume, are smaller than its sibling's.