John Nicholas, 28, has just become one of the very few patients to receive a kidney transplant while completely awake.
His doctors spoke to him throughout the procedure as his abdomen was flayed open on an operating table. At one point, they even walked over to show him the new organ that would be placed inside his body to cure his kidney failure.
Less than a day after the surgery, the Chicago-based man was discharged from the hospital to recuperate at home, despite the average five-day hospital stay for this kind of procedure. Mr Nicholas didn’t even require opioid pain killers 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 Mr Nicholas’ can cut down on some of the risks of transplant surgery – including breathing problems, blood loss, infection and death.
People with chronic conditions like diabetes, heart or lung disease are at higher risk of developing complications when put to sleep for surgery, which can make it difficult for those in need to get a new kidney or other organ.
Keeping patients awake while numbing part of their body reduces some of these risks, Dr Nadig explained, ‘basically making this an outpatient procedure.’
At the end of the surgery, John Nicholas posed with his surgical team to celebrate the successful procedure
Mr Nicholas was discharged from the hospital a day after his operation, and said within days he was walking around, feeling ‘back to normal’
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.
‘At one point during surgery, I recall asking, “should I be expecting the spinal anesthesia to kick in?” They had already been doing a lot of work and I had been completely oblivious to that fact.
‘Truly, no sensation whatsoever. I had been given some sedation for my own comfort, but I was still aware of what they were doing. Especially when they called out my name and told me about certain milestones they had reached.’
Mr Nicholas’ kidney problems stemmed from a Crohn’s disease diagnosis at age 16.
Crohn’s disease effects more than half a million Americans, according to Mayo Clinic. The condition involves frequent inflammation of the bowel 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 do appear to be at an increased risk for developing kidney failure.
Research from Cleveland Clinic gastroenterologists found eight percent of people with Crohn’s 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 sending waste out of your body through your urine. If your kidneys stop functioning, waste builds up in your system.
This initially causes nausea, swelling, confusion and fatigue, according to the Cleveland Clinic. In time, if left untreated, it can lead to kidney failure and be fatal.
For years, Mr Nicholas was able to manage the disease through medication and strict diet, limiting his salt intake and giving up some of his favorite foods like pizza.
But in 2022, during a routine check up, Northwestern doctors told Mr Nicholas his kidneys were declining and he would need a transplant to replace one.
His 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’ 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, growing up in a suburb of Indianapolis called Zionsville. Mr Wise decided to donate his kidney to his lifelong friend
Mr Nichols said he’s looking forward to having more energy to do the things he loves, like bike riding. 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 potential of being his donor.’
Luckily, 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 have each other’s backs. It meant the world to me. It’s truly been life-changing,’ Mr Nicholas said.
Kidney transplants can be performed as ‘living donations’ because humans have two of these crucial organs – and if you’re healthy, you can live with only one kidney, as long as it’s functioning properly.
Under typical circumstances, healthy patients are put to sleep for surgery using general anesthesia, and have a tube put in their throat to help them breathe. Usually, this is a low-risk option, though it does have the potential for rare complications like lung collapse and allergic reactions.
But many people who have chronic conditions, such as diabetes, heart disease, high blood pressure or obesity have an increased risk of not waking up after being put under, making any procedures more high risk.
Having any of these conditions could also put you more at risk for developing cognitive dysfunction or breathing problems during or after surgery.
Surgeons showed Mr Nicholas the kidney that was going to be transplanted into his body during the surgery.
However, in a surgery like Mr Nicholas’ patients are not put to sleep.
Instead, doctors can inject a numbing agent directly into a patient’s spine, as is done in C-sections, allowing them to stay awake during the procedure but feel nothing in the part of their body undergoing surgery.
This lets the patient keep breathing on their own and regulate their own heart rate, Dr Nadig said.
And the less doctors interfere with those normal functions, the easier it usually is for a patient to recover.
‘I truly feel that less is more,’ Dr Nadig said in a Northwestern press release.
He added: ‘Our hope is that awake kidney transplantation can decrease some of the risks of general anesthesia while also shortening a patient’s hospital stay.’
In 2021, the latest data available, 25,550 kidney transplants were performed in the United States and 72,860 more people were on the waitlist for the organ.
Mr Nicholas didn’t actually have any risk factors that would make him unable to be put to sleep for surgery. Aside from his kidney dysfunction, he was considered in good health.
But it was the fact he was low risk that doctors decided to try this procedure with him, since he was likely more resilient than the less stable patients that might require this in the future.
While Mr Nicholas may be the most recent, he is not the first patient to have the procedure.
A 63-year-old man in the United Kingdom received a kidney transplant while awake in 2010. And surgeons in India have performed this technique on more than 40 patients over a four month period in 2008.
But this is the first time doctors at Northwestern have performed the procedure in this way, and they said they’re looking to build out a program around it.
It’s unclear from the literature if this has happened anywhere else in the United States, but it is a first for the Northwestern hospitals.
