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Surgeons perform kidney transplant with patient awake during procedure

Man awake for kidney transplant surgery
Man gets kidney transplant surgery while awake 01:45

Surgeons at Northwestern Medicine performed a kidney transplant on an awake patient, marking a first for the Chicago-based healthcare system. 

The patient, 28-year-old John Nicholas of Chicago, felt no pain during the May 24 procedure and was discharged the next day. Typically a patient is hospitalized for 2-3 days following a kidney transplant at Northwestern Memorial Hospital, while the national average for a hospital stay after a kidney transplant is seven days.

"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 in a news release, adding he felt "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."

Instead of normal general anesthesia, doctors used a single-spinal anesthesia shot, which is similar to what's used during cesarean sections

"It was truly life-changing," Nicholas said at a news conference Monday.

Nicholas needed "zero opioid narcotic pain medication — so just that, in and of itself, is great," Dr. Satish Nadig, transplant surgeon and director of the Northwestern Medicine Comprehensive Transplant Center, said at the news conference. 

John Nicholas awake in the operating room.  José M. Osorio

The other exciting element? "The patient was able to be discharged home in less than 24-hours, basically making this an outpatient procedure," Nadig said in a 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."

It may also offer increased accessibility for those who are at higher risk to undergo general anesthesia.

"Patients with cognitive dysfunction, heart or lung disease — general anesthesia poses an even greater risk to their overall health. So by doing a spinal anesthetic for the kidney transplantation, we were able to bypass these risks associated with general anesthesia," Dr. Vicente Garcia Tomas, anesthesiologist and chief of regional anesthesiology and acute pain medicine at Northwestern Memorial Hospital, said during Monday's news conference.

While this wasn't the case for Nicholas, he was a candidate thanks to "his age, limited risk factors and eagerness to participate in a medical first," Nadig said at the conference. 

"During surgery, I was even able to able to show John his kidney, which was the first time I've ever been able to do that with a patient," he added. "Because of John, he's moving the entire field of transplantation forward."

Nicholas said the moment he was able to see the organ in his doctor's hand was "extremely powerful."

Nicholas began having kidney issues at 16 after being diagnosed with Crohn's disease years prior. Though he was able to manage his condition for years with medication, in early 2022 his declining kidney function made it clear he would need a transplant.

With his mom unable to donate following a breast cancer diagnosis, his childhood best friend, 29-year-old Pat Wise, didn't hesitate to fill out a donor form and was declared a match. 

"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," Nicholas said, who added he's looking forward to having more energy for bicycle rides and enjoying pizza after having to previously limit his salt intake.

During the news conference, Wise surprised Nicholas with a pizza delivery.

"John and Pat are a great example of why organ donation is important, how it can be life-changing (and) can also lead to the ultimate pizza party," Nadig said.

The transplant team at the end of surgery.  José M. Osorio

Now Northwestern Medicine is looking to establish the AWAKE Program (Accelerated Surgery Without General Anesthesia in Kidney Transplantation) for other patients who want a similar operation.

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

Editor's note: This procedure was the first of its kind for Northwestern Medicine, not the first ever. The story and headline have been updated.

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