Could being awake during a kidney transplant become the norm?

Could being awake during a kidney transplant become the norm

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    “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 to 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.

    Today we find ourselves at an inflection point for transplantation“, Mr. 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.“, pleads Mr. Nadig, as this year marks the 70th anniversary of the first successful human kidney transplant from a living donor.

    General anesthesia usually 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 cardiac or pulmonary complications for some people.

    “It was incredible”

    A father of six, Mr Stackhouse first experienced flu-like symptoms in late 2019. They worsened to the point where he could barely walk.

    A few months later, this painter and decorator found himself in the emergency room where he learned that in addition to having contracted Covid-19, one of his kidneys was failing and the other was only functioning at 2%.

    He was forced to undergo dialysis sessions three times a week, but his condition worsened and his daughter Trewaunda urged him to consider a transplant and offered to test her compatibility to see if she could become his donor.

    Initially reluctant, Mr. Stackhouse eventually agreed.

    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.“, Mr Stackhouse told AFP. He spoke with the medical team during the operation and when they offered him to see the kidney that was going 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.

    After the operation, Mr. Stackhouse has made a good recovery, walking, mowing the lawn and preparing his boat for a future fishing trip.

    He recovered even faster than his 45-year-old daughter, Trewaunda, who underwent general anaesthetic.

    It’s just a gift you can give to someone (…) you give them back their 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 up (patient) recovery across all surgical disciplines” 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.

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