Doctors in the U.S. have successfully performed kidney transplant surgery on a man who was awake throughout the whole procedure.
On May 24, John Nicholas became the first person at Northwestern Medicine in Chicago to receive a new kidney without general anesthetic and to go home the next day. It's not the first time this approach has been used worldwide, but it's far from routine.
The 28-year-old was discharged in under 24 hours, whereas kidney transplant patients would typically remain at the hospital for several days or up to a week.
During Nicholas' surgery, doctors injected anesthetic into the fluid that surrounds the lower spinal cord. At the same time, they lightly sedated him for comfort, according to a statement. Sedation is used to make a patient relaxed and drowsy without causing them to lose consciousness.
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The surgery took less than two hours, and Nicholas didn't feel any pain. At one point during the procedure, he even got to see his new kidney, which was donated by his best friend, Pat Wise, before it was implanted into his body.
"That particular moment where I saw the kidney in Dr. Nadig's hands — like [it was] extremely powerful to see that," Nicholas said at a press conference Monday (June 24). Within 24 hours of the procedure, Nicholas walked out of the hospital.
Nicholas had experienced kidney issues since he was 16, which culminated in the need for a transplant. Lab work revealed inflammation was damaging his kidneys, but its exact cause has not been determined.
Now, several weeks after surgery, Nicholas is back to being active and can enjoy a less restrictive diet, including being able to treat himself to his favorite pizza, according to the statement. He'd had to limit his salt intake prior to getting surgery because excess salt can have detrimental impacts on kidney function.
"I've hit 10,000 steps, I think, every day in the last week and I don't do that normally. So definitely doing well," Nicholas said.
This isn't the first time that spinal and local anesthetic rather than general anesthesia has been used during kidney transplantation, Dr. Satish Nadig, one of the surgeons who performed the transplantation, said at the press conference. Local anesthetic is also used for a range of major surgeries, including joint replacements and cesarean sections.
However, kidney transplants, which have saved hundreds of thousands of lives in the U.S. alone, are usually performed under general anesthetic. Most patients also have to spend several days to a week recovering in the hospital afterward. This is partly because general anesthesia can temporarily affect a patients' memory, concentration and reflexes.
This new approach really challenges the "status quo" of kidney transplantation, especially given that Nicholas recovered so quickly after surgery, Nadig said. This status quo has remained more or less the same since the first successful human kidney transplant was performed in 1954, he said.
Avoiding general anesthesia could potentially reduce patients' hospital stays, which would also reduce the time in which they could potentially pick up hospital-acquired infections.
The new approach could also make transplant surgery more accessible to patients who are at a higher risk of complications from general anesthesia. This includes older individuals with some degree of cognitive dysfunction or heart or lung disease, Dr. Vincente Garcia Tomas, an anesthesiologist who helped perform the surgery, said at the press conference. Some people are also fearful of going under general anesthesia, and this could offer an alternative option.
Nicholas is young and has few risk factors that increase the likelihood of complications from general anesthesia, the team noted. His decision to participate in this pioneering surgery could eventually help many other patients for whom the procedure might be more dangerous.
"He put his trust in us and because of John, he's moving the entire field of transplantation forward," Nadig said.
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