Kidney Transplant | Could Being Awake During Surgery Become the Norm?

(Washington) “I saw it all”: At 74, Harry Stackhouse watched as doctors transplanted a new kidney into his body. A painless experience that allowed him to talk with surgeons, see his new organ and watch the medical team stitch it back together.

Mr. Stackhouse underwent surgery on July 15 in the Chicago area at the American establishment Northwestern Medicine, which is seeking to generalize these transplants performed without general anesthesia.

Completed in just over an hour, the operation was the second of its kind for Satish Nadig, director of the Chicago-based Comprehensive Transplant Center. He has since performed a third.

“We are now at an inflection point for transplantation,” Nadig told AFP.

Although medical literature has reported for several decades and in different countries a few kidney transplants performed on awake patients using the same technique as a cesarean section, this practice has never been fully adopted.

“It is time to question the paradigms to which we have historically attached ourselves,” argues Mr. Nadig, as this year marks the 70th^e anniversary of the first successful human kidney transplant from a living donor.

General anesthesia typically requires intubation, which can damage the vocal cords, disrupt bowel movements, and create persistent “brain fog,” especially in older patients. It can also pose a risk of more serious, but rare, heart or lung complications for some people.

“It was incredible”

A father of six, Stackhouse first experienced flu-like symptoms in late 2019. They got so bad that he could barely walk. A few months later, the painter and decorator found himself in the emergency room, where he learned that in addition to having COVID-19, one of his kidneys was failing and the other was functioning at only 2%.

He is forced to undergo dialysis three times a week, but his condition worsens and his daughter Trewaunda urges him to consider a transplant and offers to test her as a match to see if she can become his donor. Initially reluctant, Mr Stackhouse eventually agrees.

His meeting with Professor Nadig and the discovery of the program for surgery without general anesthesia, the “AWAKE Kidney Program”, made his decision.

“Believe it or not, I didn’t feel a thing – it was incredible,” Stackhouse told AFP. He chatted with the medical team during the operation and when they offered him a chance to see the kidney that was to be transplanted, he accepted without hesitation. “I didn’t think a kidney was that big!”

Given his age, Mr Stackhouse was able to go home 36 hours after the operation. Professor Nadig’s first patient, operated on in May, was discharged after 24 hours, well short of the average five to seven days for an operation under general anaesthetic.

” A gift ”

Satish Nadig attributes this success to scientific advances such as the ability to target anesthesia to the abdomen or spine.

Avoiding opioids and encouraging patients to eat promptly after surgery had already reduced average patient stays.

Mr Stackhouse has made a good recovery since the operation, walking, mowing the lawn and preparing his boat for a future fishing trip. He has recovered even faster than his 45-year-old daughter, Trewaunda, who underwent a general anaesthetic.

“It’s just a gift you can give to someone […] “You give him back his quality of life,” the teacher explained to AFP.

Christopher Sonnenday, director of the Transplant Center at the University of Michigan Medical School, praised the “important innovation” achieved by the Northwestern Medicine team.

“Reducing the use of general anesthesia has been shown to be effective in speeding recovery [des patients] in all disciplines of surgery,” he adds.

But practice will determine how widespread the procedure can be in kidney transplants, he says, and how it can be offered to patients who are obese or have heart disease, who are at greater risk of complications from general anesthesia.