John Nicholas, 28, has just become one of the few patients to have a kidney transplant while fully awake.
His doctors spoke to him throughout the procedure as his abdomen was cut open on an operating table. At one point they even walked up to him to show him the new organ that would be placed in his body to cure his kidney failure.
Less than a day after the operation, the Chicago man was released from the hospital to recover at home, despite the average hospital stay 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 the success of awake surgeries like Nicholas’s could lead to a reduction in the risks of transplant surgery – including respiratory problems, loss, infection and death.
People with chronic conditions such as diabetes, heart or lung disease are at greater risk of complications if they are put to sleep before surgery. This can make it difficult for those who need one to get a new kidney or other organ.
Keeping patients awake while part of their body is numbed reduces some of these risks, Dr. Nadig explains, “essentially making this an outpatient procedure.”
At the end of the operation, John Nicholas posed with his surgical team to celebrate the successful procedure
Mr Nicholas was discharged from hospital a day after his operation and said he was walking around and feeling ‘normal again’ within days.
Mr Nicholas said in a press release from Northwestern: “It was a pretty cool experience to know what was happening in real time and be aware of the magnitude of what they were doing.
‘I remember asking at some point during the surgery, “Should I expect the spinal anesthesia to take effect?” They had already done a lot of work and I was completely unaware of it.
‘Really, no sensation whatsoever. I had been given some anesthesia for my own comfort, but I was still aware of what they were doing. Especially when they shouted my name and talked about certain milestones they had achieved.”
Nicholas’s kidney problems stemmed from being diagnosed with Crohn’s disease at age 16.
Crohn’s disease affects more than half a million Americansaccording to Mayo Clinic. The condition is accompanied by frequent inflammation of the intestines and digestive tract, which can cause pain, diarrhea, fatigue and weight loss.
It’s not clear to doctors how Crohn’s disease affects the kidneys, but people with the disease appear to be at increased risk of developing kidney failure.
Research at the Cleveland Clinic, gastroenterologists found that eight percent of people with Crohn’s disease or a similar gastrointestinal disease experience kidney problems, compared to four percent of people without the disease.
The kidneys are responsible for filtering your blood and removing waste from your body through your urine. When your kidneys stop functioning, waste builds up in your system.
This initially causes nausea, swelling, confusion and fatigue, according to the Cleveland Clinic. If left untreated, it can lead to kidney failure over time and be fatal.
For years, Mr. Nicholas managed the disease through medication and a strict diet, which included limiting his salt intake and giving up some of his favorite foods, such as pizza.
But in 2022, doctors at Northwestern told Nicholas during a routine checkup that his kidneys were deteriorating and he needed a transplant to replace one.
His mother quickly volunteered to donate her kidney, but was diagnosed with breast cancer shortly afterwards and was no longer eligible to donate.
So Mr. Nicholas’ childhood friend, Pat Wise, 29, who lives in Virginia, offered to take her place.
Mr. Nicholas and Pat Wise, his donor, have known each other since they were children and grew up in a suburb of Indianapolis called Zionsville. Mr. Wise decided to donate his kidney to his lifelong friend
Mr Nichols said he is looking forward to having more energy to do the things he loves, such as cycling. He’s also looking forward to eating pizza again
Mr Wise said: “John is a good friend. He needed a kidney, and I had an extra one. I had to at least explore the possibilities 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 surgery.
“We always called ourselves ‘ride or die’ friends, and this example shows that we support each other. It meant everything to me. It really has been life-changing,” Mr Nicholas said.
Kidney transplants can be done as ‘living donations’ because people have two of these crucial organs – and if you are healthy, you can live with just one kidney, as long as it is functioning properly.
Under typical circumstances, healthy patients are put to sleep for surgery under general anesthesia, and a tube is inserted down their throat to help them breathe. This is usually a low-risk option, although rare complications can occur such as lung collapse and allergic reactions.
But many people with chronic conditions, such as diabetes, heart disease, high blood pressure, or obesity, are at increased risk of not waking up after being submerged, making any procedure more risky.
If you have any of these conditions, you may also be more at risk for developing cognitive impairment or breathing problems during or after surgery.
Surgeons showed Mr Nicholas the kidney that would be transplanted into his body during the operation.
However, an operation like Mr. Nicholas’s does not put patients to sleep.
Instead, doctors can inject an anesthetic directly into a patient’s spine, as is done with C-sections, allowing them to remain awake during the procedure but not feel anything in the part of their 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 usually is for a patient to recover.
“I really feel like less is more,” says Dr. Nadig said in a Northwestern press release.
He added: ‘Our hope is that awake kidney transplantation can reduce some of the risks of general anesthesia while shortening a patient’s hospital stay.’
The most recent data available is 2021 25,550 kidney transplants were performed in the United States and another 72,860 people were on the waiting list for the organ.
Mr. Nicholas actually had no risk factors that prevented him from being put to sleep for surgery. Apart from his renal impairment, he was considered in good health.
But it was the fact that he was at little risk that doctors decided to try this procedure on him, as he was likely to be more resilient than the less stable patients who might need it in the future.
While Mr. Nicholas may be the most recent, he is not the first patient to undergo the procedure.
A 63-year-old man in Britain developed a kidney transplant while awake in 2010. And surgeons in India have performed this technique on more than 40 patients in more than a year period of four months in 2008.
But this is the first time Northwestern doctors have performed the procedure this way, and they said they want to build a program around it.
It is unclear from the literature whether this has happened elsewhere in the United States, but it is a first for hospitals in the Northwestern United States.