If you heard that someone was receiving a kidney transplant, you might naturally assume they’d have to spend at least a few days in hospital afterward. You might also assume that they would be put to sleep for the procedure. A 28-year-old man from Chicago just managed to buck both of those trends by receiving a kidney transplant while awake and being discharged from hospital the very next day. 

The case, a first for Northwestern Medicine, is certainly unusual. Kidney transplants under local anesthesia have been performed elsewhere before, but it’s still very much the norm that the procedure is carried out under a general anesthetic. While you might not fancy the idea of being aware of what’s going on while surgeons are putting a new kidney inside you, it actually has a lot of potential benefits.

“Doing anesthesia for the awake kidney transplant was easier than many C-sections,” commented anesthesiologist Vicente Garcia Tomas, MD, in a statement. 

“Our hope is that awake kidney transplantation can decrease some of the risks of general anesthesia while also shortening a patient’s hospital stay. 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,” added transplant surgeon Satish Nadig, MD, PhD. 

The patient in question was John Nicholas, who first developed kidney issues at the age of 16, following an earlier diagnosis of Crohn’s disease. The root cause of the inflammation in his kidneys was never identified, but over time, and despite medication, it became clear that he would need a transplant.

Finding a donor was another hurdle, but luckily his childhood best friend Pat Wise was eager to step up to the plate.

“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,” Wise recalled. “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.”

After Wise was declared a match, the surgery went ahead on May 24, 2024. 

“For John’s case, we placed a spinal anesthesia shot in the operating room with a little bit of sedation for comfort,” Garcia Tomas explained. “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.”

For his part, Nicholas gave the procedure a glowing review. “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,” he said, recounting how the local anesthetic made the procedure completely painless although he was aware of what the surgeons were doing. 

The very next day, Nicholas walked out of hospital. A typical kidney transplant patient at the same hospital would require an inpatient stay of 2-3 days. 

The success of the procedure raises the possibility of using this method in more complex cases, such as those in which the patient is unable to undergo general anesthesia for other medical reasons. “It really opens up a whole new door and is another tool in our toolbelt for the field of transplantation,” said Nadig. 

Since the operation, Nicholas has been recovering well, and expressed his gratitude to Wise for being able to step in when his mother, originally intending to be his donor, was unable to help due to her own cancer diagnosis. 

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