John Nicholas, 28, just became one of the few patients to receive a kidney transplant while fully awake.
His doctors talked him through the procedure as his abdomen was scraped open on an operating table. At one point, they even came to show him the new organ that would be placed inside his body to cure his kidney failure.
Less than a day after surgery, the Chicago-based man was released from the hospital to recover at home, despite an average hospitalization of five days for this type of procedure. Mr. Nicholas didn’t even need opioid painkillers to recover.
One of the surgeons on the case, Dr. Satish Nadig, director of the Northwestern Medicine Comprehensive Transplant Center, said doctors hope that the success of awake surgeries like Mr. Nicholas’s can reduce some of the risks associated with transplantation – including respiratory problems, bleeding. loss, infection and death.
People with chronic illnesses like diabetes, heart or lung disease are at higher risk of developing complications while asleep for surgery, which can make it difficult to get a new kidney. or another organ for those who need it.
Keeping patients awake while numbing part of their body reduces some of these risks, Dr. Nadig explained, “by essentially making it an outpatient procedure.”
At the end of the operation, John Nicholas posed with his surgical team to celebrate the success of the operation.
Mr Nicholas was released from hospital a day after his operation and said that a few days later he was walking around, feeling “back to normal”.
Mr. Nicholas said in a Northwestern press release: “It was a pretty cool experience knowing what was happening in real time and being aware of the magnitude of what they were doing.
“At one point during the surgery, I remember asking, ‘Should I expect the spinal anesthesia to kick in?’ » They had already done a lot of work and I was completely unaware of it.
“Really, no feeling. I had been given a sedative for my own comfort, but I was still aware of what they were doing. Especially when they called me by name and told me about some milestones they had reached.
Mr. Nicholas’ kidney problems stemmed from a diagnosis of Crohn’s disease when he was 16 years old.
Crohn’s disease affects more than half a million Americansaccording to Mayo Clinic. The condition involves frequent inflammation of the intestine and digestive tract, which can cause pain, diarrhea, fatigue and weight loss.
Doctors aren’t sure how Crohn’s disease affects the kidneys, but people with Crohn’s disease appear to be at increased risk of developing kidney failure.
Research by Cleveland Clinic gastroenterologists found that eight percent of people with Crohn’s disease or a similar gastrointestinal illness have kidney problems, compared to four percent of people without Crohn’s disease. disease.
The kidneys are responsible for filtering your blood and removing waste from your body through urine. If your kidneys stop working, waste builds up in your system.
According to the Cleveland Clinic, this initially causes nausea, swelling, confusion and fatigue. Over time, if left untreated, it can lead to kidney failure and be fatal.
For years, Mr. Nicholas managed the disease with medication and a strict diet, limiting his salt intake and giving up some of his favorite foods like pizza.
But in 2022, during a routine check-up, doctors in the North West told Mr Nicholas his kidneys were failing and he would need a transplant to replace one.
Her mother quickly volunteered to donate her kidney, but was diagnosed with breast cancer shortly after and was no longer eligible to donate.
So Mr. Nicholas’s childhood friend, Pat Wise, 29, who lives in Virginia, offered to replace her.
Mr. Nicholas and Pat Wise, his donor, have known each other since they were children growing up in an Indianapolis suburb called Zionsville. Mr Wise decided to donate his kidney to his lifelong friend
Mr Nichols said he hoped to have more energy to do the things he loves, like cycling. He also can’t wait to eat pizza again
Mr Wise said: “John is a good friend. He needed a kidney and I had one more. I had to at least explore the potential of being his donor.
Fortunately, it was a match and Mr. Wise was able to donate his kidney to his best friend after flying to Chicago for the operation.
“We’ve always called each other ‘ride or die’ friends, and this example shows that we have each other’s backs. It meant the world to me. It really changed my life,” Mr Nicholas said.
Kidney transplants can be done as “living donations” because humans have two of these essential organs – and if you’re healthy, you can live with just one kidney, as long as it’s functioning properly.
In typical circumstances, healthy patients are sedated for surgery under general anesthesia and have a tube put down their throat to help them breathe. This is generally a low-risk option, although it can cause rare complications like lung collapse and allergic reactions.
But many people with chronic illnesses, such as diabetes, heart disease, high blood pressure or obesity, are at increased risk of not waking up after being subjected, making any procedure riskier.
Having one of these conditions could also put you at greater risk of developing cognitive dysfunction or breathing problems during or after surgery.
Surgeons showed Mr Nicholas the kidney that would be transplanted into his body during the operation.
However, in an office like Mr. Nicholas’s, patients are not asleep.
Instead, doctors can inject a numbing agent directly into a patient’s spine, as is done during a cesarean section, allowing them to stay awake during the procedure but not feel anything in the part of his body undergoing surgery.
This allows the patient to continue breathing on their own and regulate their own heart rate, Dr. Nadig said.
And the less doctors interfere with these normal functions, the easier it is usually for the patient to recover.
“I really think less is more,” Dr. Nadig said in a Northwestern press release.
He added: “Our hope is that an awake kidney transplant can decrease some of the risks of general anesthesia while also shortening a patient’s hospital stay. »
In 2021, according to the latest available data, 25,550 kidney transplants were performed in the United States and an additional 72,860 people were on the waiting list for the organ.
Mr. Nicholas actually had no risk factors that would prevent him from falling asleep for surgery. Besides his kidney dysfunction, he was considered in good health.
But it was because he was low risk that doctors decided to try this procedure on him, as he was likely more resilient than less stable patients who might need it in the future.
Although Mr. Nicholas may be the newest, he is not the first patient to undergo this procedure.
In the United Kingdom, a 63-year-old man received a kidney transplant while he was awake in 2010. And Indian surgeons performed the technique on more than 40 patients over a four-month period in 2008.
But this is the first time Northwestern doctors have performed the procedure in this way, and they said they are looking to build a program around it.
It is unclear from the literature whether this has occurred elsewhere in the United States, but it is a first for Northwest hospitals.
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