John Nicholas, a 28-year-old American, who developed kidney problems due to his Crohn’s disease, was transplanted with the kidney of his childhood friend Pat Wize on May 24, 2024. If this selfless gesture is very touching, another element gives an even more impressive scope to this story.
The transplant patient was not asleep during this operation performed by doctors at Northwestern Medicine (Chicago) and was back home less than 24 hours after surgery.
Awake transplant: reducing the risks of general anesthesia
Nicholas began suffering from kidney problems at age 16. It was a complication of his Crohn’s disease diagnosed a few years earlier. His kidney function gradually declined. To the point that in 2022, the option of a kidney transplant was put forward by his nephrologist. When searching for a suitable donor, his childhood friend immediately volunteered.
That’s when the Northwestern Medicine team suggested Nicholas have the transplant done, not under general anesthesia, but under spinal anesthesia. This is a method similar to that used during cesarean sections. The drug is injected into the spinal fluid at the level of the lumbar vertebrae.
“This is the first case at Northwestern Medicine where a patient was awake during an entire kidney transplant procedure and went home the next day, making it essentially an outpatient procedure. Our hope is that awake kidney transplantation may reduce some risks of general anesthesia, while shortening a patient’s hospital stay”explains Dr. Satish Nadig, transplant surgeon and director of the Northwestern Medicine Comprehensive Transplant Center, in a press release published June 24.
“In the operating room, it was an incredible experience to be able to show a patient what their new kidney looked like before placing it in the body”adds the expert.
Kidney transplant awake: “it was a pretty cool experience…”
And the experience appears not to have been traumatic for Nicholas. “It was a pretty cool experience knowing what was happening in real time and being aware of the scale of what they were doing, confides the patient. At one point during 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 of the steps they had taken.”
In addition to being a solution for people with risks or a phobia of general anesthesia, this method has an advantage: it helps to shorten the hospital stay after the procedure. Nicholas was, in fact, discharged the day after his transplant, while the stay for this type of procedure is usually 2 to 3 days with general anesthesia.
After this first within its walls, the American hospital plans to launch a program, called AWAKE. The latter will suggest to patients – for whom it could be beneficial – to have recourse to spinal anesthesia, rather than general. However, it will only be available for kidney transplants initially. “It really opens a whole new door and is another tool in our tool palette for the field of transplantation,” concludes Dr Satish Nadig.
