Northwestern Medicine Surgeons Perform Awake Kidney Transplant with Next Day Discharge

“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, basically making this an outpatient procedure. Our hope is that awake kidney transplantation can decrease some of the risks of general anesthesia while also shortening a patient’s hospital stay,” said Satish Nadig, MD, PhD, transplant surgeon and director of the Northwestern Medicine Comprehensive Transplant Center. “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.”

On May 24, Dr. Nadig, Vinayak Rohan, MD, transplant surgeon at Northwestern Memorial Hospital, and Vicente Garcia Tomas, MD, anesthesiologist and chief of regional anesthesiology and acute pain medicine at Northwestern Memorial Hospital, performed the surgery which took less than two hours. The patient received a type of anesthesia that’s similar to what’s used during a cesarean section.

“Doing anesthesia for the awake kidney transplant was easier than many C-sections,” said Dr. Garcia Tomas. “For John’s case, we placed a 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. Not only can awake kidney transplantation help patients who have risks or phobias to general anesthesia, but it can help shorten their hospital stay so they can recover more comfortably at home.”

Nicholas didn’t have any risks or phobias to general anesthesia but was a great candidate for the procedure due to his age, limited risk factors and his eagerness to participate in a medical first for Northwestern Medicine.

“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,” said Nicholas. “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.”

After a successful surgery on May 24, Nicholas was discharged the next day and walked out of the hospital on May 25. The normal hospitalization for patients who undergo a kidney transplant at Northwestern Memorial Hospital is typically 2-3 days.

Nicholas’ best friend since elementary school donates kidney to him 

At the age of 16, Nicholas began having kidney issues after being diagnosed with Crohn’s disease years prior. Routine lab work showed his kidney function had declined and further testing determined there was inflammation in his kidneys that was causing damage, but the root cause was never found.

He was able to avoid dialysis and managed it with medication. But after moving to Chicago in early 2022 and establishing care at Northwestern Medicine, his kidney function declined, and it became clear he would eventually need a kidney transplant.

Nicholas credits his Northwestern Medicine nephrologist, Cybele Ghossein, MD, for directing him through the pre-transplant workup and stretching out the life of his natural kidneys as long as possible.

But there were some challenges in finding Nicholas a donor. His mother originally planned to be his donor but was then unable to donate following a breast cancer diagnosis. Nicholas then turned to the group of friends he’s known since elementary school while growing up in the Indianapolis suburb of Zionsville, Indiana. His best friend, 29-year-old Pat Wise who lives in Alexandria, Va., and works for a public health agency, remembers getting that 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,” said Wise. “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 Nicholas.

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

Before the transplant, Nicholas had to limit his salt intake, but is now looking forward to enjoying pizza and having more energy to ride his bicycle around Chicago.

“When John agreed to be the first known patient at Northwestern Medicine to undergo an awake kidney transplant and be discharged home the next day, he knew the benefits outweighed the risks, and because of him, he’s now helping to move the field of transplantation forward,” said Dr. Rohan. “He is an extremely compliant patient who was in tune with his body and willing to push the envelope. He had the upmost faith in us, and we had the upmost faith in him. He really was otherwise quite healthy, and we felt we that he would be the best first candidate to really set Northwestern Medicine’s awake kidney transplant program up for success.”

Going forward, Northwestern Medicine will look to establish the AWAKE Program (Accelerated Surgery Without General Anesthesia in Kidney Transplantation) for a particular subsets of patients that want the operation, can’t have general anesthesia or have a high-risk of general anesthesia, or fit into a category where this could benefit the patient.

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

To learn more about Northwestern Medicine’s kidney transplant program, visit nm.org.

Northwestern Medicine Surgeons Perform Awake Kidney Transplant with Next Day Discharge