• Posted June 24, 2024

Surgeons Perform a U.S. First: Kidney Transplant in Awake Patient

John Nicolas was deep into kidney transplant surgery when he decided to ask his doctors if they'd started yet.

"At one point during surgery, I recall asking, 'Should I be expecting the spinal anesthesia to kick in?'"Nicolas, 28, recalled in a news release. "They had already been doing a lot of work and I had been completely oblivious to that fact. Truly, no sensation whatsoever."

Nicolas, a Chicago resident, is the first person known to receive a kidney transplant while awake in the United States, say his doctors at Northwestern Medicine in Chicago.

Instead of using the normal general anesthesia, doctors used a single spinal anesthesia injection to numb Nicolas while allowing him to remain alert.

This new option could make transplantation available to patients whose health makes them a high risk for general anesthesia, doctors say.

It also could substantially decrease the length of a transplant patient's hospital stay. 

Nicolas walked out of the hospital the day after his successful surgery, which occurred on May 24. Typically, kidney transplant patients spend two to three days in the hospital, doctors said.

"Inside the operating room, it was an incredible experience being able to show a patient what their new kidney looked like before placing it inside the body,"Dr. Satish Nadig, a transplant surgeon and director of the Northwestern Medicine Comprehensive Transplant Center, said in a news release.

"The other exciting element is that the patient was able to be discharged home in less than 24 hours, basically making this an outpatient procedure,"Nadig added in a Northwestern news release. "Our hope is that awake kidney transplantation can decrease some of the risks of general anesthesia while also shortening a patient's hospital stay."

Nicolas' surgical team performed his kidney transplant in less than two hours, using a type of anesthesia similar to that employed during a cesarean section.

"Doing anesthesia for the awake kidney transplant was easier than a C-section,"Dr. Vicente Garcia Tomas, chief of regional anesthesiology and acute pain medication at Northwestern Memorial Hospital, said in a news release. "For John's case, we placed a single-spinal anesthesia shot in the operating room with a little bit of sedation for comfort. It was incredibly simple and uneventful, but allowed John to be awake for the procedure, improving the patient experience."

Nicolas didn't have any health risks that would have prohibited general anesthesia, nor did he have any phobia about it.

In fact, his age and limited risk factors made him an ideal candidate to participate in a medical first, and Nicolas leapt at the opportunity.

"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,"Nicholas said.

"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,"Nicolas added.

Nicolas began having kidney problems at age 16. His kidney function declined, and testing showed inflammation in his kidneys was damaging them, although the root cause was never found.

He was able to avoid dialysis through medication until recently, when his kidneys failed further and it became clear he would need a kidney transplant.

Nicolas' mom originally planned to be his donor, but that fell through following a breast cancer diagnosis.

Next he turned to a group of friends he's known since elementary school, growing up in the Indianapolis suburb of Zionsville.

His best friend now lives in Alexandria, Va., and works for a public health agency. Pat Wise, 29, remembers getting the text.

"I was in my kitchen cooking dinner and John sent a message that read, 'my doctor says it's time for me to start looking for kidney donors.' I stared at my phone and without hesitating, filled out the form that night,"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."

Wise was declared a match and traveled to Chicago, where surgeons removed one of his kidneys and transplanted it into Nicolas.

"I have been blessed with a friend group that has stayed together from such a young age,"Nicholas said. "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."

To keep his kidneys healthy, Nicholas had to limit his salt intake. Now he's looking forward to enjoying more pizza and having the energy to ride his bicycle around Chicago.

"He is an extremely compliant patient who was in tune with his body and willing to push the envelope,"said Dr. Vinayak Rohan, a transplant surgeon at Northwestern Memorial Hospital. "He had the upmost faith in us, and we had the upmost faith in him."

Northwestern Medicine plans to make this sort of surgery available to patients who can't have general anesthesia or might otherwise benefit from it.

"It really opens up a whole new door and is another tool in our toolbelt for the field of transplantation,"Nadig said.

More information

The National Institutes of Health has more on kidney transplants.

SOURCE: Northwestern Medicine, news release, June 24, 2024