Revolutionary Kidney Transplants: Patients Stay Awake for Surgery!

A New Era in Kidney Transplant Surgery: Patients Stay Awake with Spinal Anesthesia

In a groundbreaking approach that challenges traditional kidney transplant procedures, 74-year-old Harry Stackhouse, a patient from Illinois, recently underwent a kidney transplant while fully awake. Rather than being placed under general anesthesia, Stackhouse was given a spinal anesthetic, allowing him to stay conscious throughout the entire operation. He was able to chat with the surgical team, examine the donor kidney, and even watch as the doctors stapled him up after the transplant. The entire procedure took just over an hour, and Stackhouse was discharged from the hospital 36 hours later—significantly faster than the typical recovery time for transplant patients who undergo general anesthesia.

This innovative approach, part of the AWAKE Kidney Program at Northwestern Medicine, could signal a new era in transplantation. The program, which uses spinal anesthesia to perform kidney transplants, not only helps patients recover faster but also avoids some of the common complications associated with general anesthesia. While the idea of undergoing surgery while awake might seem off-putting or even frightening to some, the medical benefits of this technique are well-supported by scientific research and clinical experience.

Why Stay Awake?

General anesthesia is a standard practice for most major surgeries, including kidney transplants. However, it comes with its own set of risks. Intubation, which is required for general anesthesia, can cause damage to the vocal cords, delay bowel function, and contribute to post-operative confusion or "brain fog," particularly in older patients. Additionally, the use of general anesthesia typically leads to longer recovery times and extended hospital stays.

By contrast, spinal anesthesia involves the injection of a local anesthetic into the spinal fluid, numbing the lower half of the body while allowing the patient to remain awake and alert. This approach is already widely used for procedures such as cesarean sections and certain types of orthopedic surgeries. The success of the AWAKE Kidney Program at Northwestern Medicine demonstrates that spinal anesthesia can be safely and effectively used for kidney transplants as well.

Dr. Satish Nadig, the director of Northwestern Medicine's Comprehensive Transplant Center, led the first-ever awake kidney transplant at the hospital and has since completed multiple procedures using this technique. According to Dr. Nadig, the shift to spinal anesthesia represents a significant advancement in kidney transplantation, thanks to improvements in anesthetic technology and surgical techniques.

"We're at an inflection point in transplantation today in being able to use the technologies that we have around us to really push us into this next era," Dr. Nadig stated. While the concept of awake surgery has been explored in various forms over the years, it has never been widely implemented for kidney transplants—until now.

A Life Restored

Harry Stackhouse’s journey to a successful kidney transplant began in late 2019, when he first started feeling unwell with flu-like symptoms. His health quickly deteriorated, and by the time he was hospitalized, he was diagnosed with kidney failure. He learned that his kidneys were functioning at dangerously low levels, and he was forced to begin dialysis. As his condition worsened, Stackhouse’s daughter, Trewaunda, offered to donate one of her kidneys, and after much deliberation, Stackhouse agreed.

Before undergoing surgery, Stackhouse met with Dr. Nadig and learned about the AWAKE Kidney Program, which uses spinal anesthesia instead of general anesthesia. Despite his initial hesitation, Stackhouse decided to move forward with the procedure.

“I didn’t feel a thing—it was amazing,” Stackhouse said after the surgery. He was able to converse with the surgical team throughout the procedure and even got a chance to see the donor kidney. "Man, I didn’t think a kidney was that big!” he exclaimed when shown the organ.

The recovery time following his surgery was remarkable. Stackhouse was discharged just 36 hours later, significantly earlier than the typical five to seven days required for patients who undergo traditional surgeries with general anesthesia. In fact, his recovery was faster than his daughter’s, who had undergone the transplant under general anesthesia.

The Benefits of Spinal Anesthesia in Transplant Surgery

The use of spinal anesthesia in kidney transplant surgery is not just a novel concept—it has tangible benefits that improve patient outcomes. One of the key advantages is that it avoids the complications often associated with general anesthesia, such as delayed bowel function, post-surgical confusion, and the risks of intubation.

Spinal anesthesia also allows patients to recover more quickly. The AWAKE Kidney Program has shown that patients who receive spinal anesthesia often experience shorter hospital stays and faster recoveries compared to those who undergo general anesthesia. This is largely due to the ability to avoid opioid narcotics, which are often necessary to manage pain in patients who have been under general anesthesia. Additionally, patients who are awake during surgery can eat and move around sooner, further accelerating recovery.

Who Will Benefit from This Approach?

While the early results of the AWAKE Kidney Program are promising, it remains to be seen how widely applicable the technique will become. The program’s success relies on several factors, including the patient’s health, the complexity of the transplant, and the overall surgical procedure. Certain patients, such as those with obesity or heart disease, may not be eligible for awake surgery due to the potential for complications.

The program’s success has also sparked interest in applying spinal anesthesia to other types of surgeries. For example, other transplant centers are now considering whether spinal anesthesia could be used for liver or heart transplants. However, more research is needed to fully understand the potential benefits and risks of awake surgery across different medical specialties.

Looking to the Future

The groundbreaking approach being pioneered at Northwestern Medicine represents just one example of how modern medical technology is pushing the boundaries of traditional surgical practices. As Dr. Nadig and his team continue to refine the technique, the potential for faster, safer kidney transplants could open the door to better outcomes for patients across the globe.

Still, experts caution that this is just the beginning of a new era in surgery. While the results thus far have been promising, more research and experience will be necessary to determine how widely applicable awake kidney transplants can be, and whether the technique can be used safely and effectively in patients with complex medical histories.

As medical professionals continue to explore innovative ways to improve surgical outcomes, the success of the AWAKE Kidney Program could lead to lasting changes in how kidney transplants are performed, offering patients a faster, less invasive path to recovery.

Conclusion

The AWAKE Kidney Program at Northwestern Medicine has ushered in a new era of transplant surgery, where patients stay awake during the procedure and recover more quickly than ever before. By using spinal anesthesia instead of general anesthesia, patients like Harry Stackhouse can undergo life-saving surgeries with fewer complications, faster recovery times, and greater overall satisfaction. While this technique is still in the early stages of widespread adoption, its success signals an exciting future for transplant surgeries, and may eventually change the way we think about anesthesia in general.