John Nicholas’ go-to karaoke song is “When You Were Young” by The Killers. He remembers hearing it come on as his surgery began, and singing along to it while on the operating table.
That’s because Nicholas, 28, was awake during his kidney transplant at Northwestern Medicine, a first for the hospital.
Nicholas, who was administered regional anesthesia, could hear what the transplant team was saying around him, but for the most part, it felt like “a lot of noise and motion and lights,” he said.
A Chicago resident originally from a north suburb of Indianapolis, Nicholas was diagnosed almost two decades ago with Crohn’s disease, a type of inflammatory bowel disease that irritates the lining of the digestive tract. Nicholas started treatment and ultimately got the disease under control, but he battled flare-ups for years.
In 2013, bloodwork indicated that his kidney function was lacking. A biopsy showed that his kidneys were inflamed, and he started taking anti-inflammatory medication, which got the situation under control.
A few years later, when Nicholas was a sophomore in college, he had another episode of heavy inflammation in his kidneys, damaging them further. At that point, it was clear that he would need a kidney transplant.
About two years ago, Nicholas got in touch with the transplant team at Northwestern. He was put on the waiting list, but was also given a questionnaire to send out to any potential living donors who wanted to be evaluated to donate.
Nicholas’ mom went through the paperwork and was cleared to be his donor, but she was diagnosed with early-stage breast cancer in December 2023, just before the transplant was to take place. Although her cancer treatment was successful, she was no longer an option as a kidney donor.
“The news came around the time I was home in Indianapolis for the holidays, and I was around my family but also my friend group,” Nicholas said.
He ended up talking to one of his childhood friends, Patrick Wise, 29, about becoming the donor.
“He had strongly considered it before when I was first sending out the questionnaire, before we were proceeding with my mom being the donor,” Nicholas said. “It fortunately did not take very long after my mom was ruled ineligible for Patrick to get cleared to donate, and he was very motivated to do that for me.”
By March, the transplant was scheduled for May 24. Nicholas was preparing for the surgery with the transplant team along with Wise, who now lives in Alexandria, Virginia, and who was flying back and forth for pre-operation appointments.
Dr. Satish Nadig, chief of transplant surgery and director of the Comprehensive Transplant Center at Northwestern, and Dr. Vinayak Rohan, a transplant surgeon and the surgical director for kidney transplant at Northwestern, were both part of Nicholas’ transplant team.
Nadig said the team approached Nicholas before the operation to discuss his options. As Nicholas was a strong candidate for an awake procedure, given his age and overall good health, Nadig said the team told him about the benefits of the procedure and also let him know the risks were minimal.
“When we first met John, we found him to be somebody who was very inquisitive, very curious,” Nadig said. “In fact, during the operation, he wanted to see the kidney as we were putting it in, and we were able to show it to him.”
While the general anesthesia used in many surgeries is “very safe,” Rohan said there is a subset of patients for whom general anesthesia carries higher risk, because of respiratory issues, age, or other issues.
Instead, some patients can have successful surgeries with regional anesthesia, where only the region of the body that’s being operated on gets anesthesia, and the patient remains awake. In Nicholas’ case, he got a spinal anesthesia shot, a form of regional anesthesia that is also less invasive and can lead to a quicker recovery time.
“If you think about it this way, the less invasive one can be for any procedure, the better off the patient is,” Rohan said.
Nadig likened a patient being under spinal anesthesia to having a C-section.
“Kidney transplants are working and have been working for decades, but we want to constantly work to make them better and even better than that,” Nadig said. “It’s amazing to think you can get a life-saving organ, and have a procedure and go home and next day.”
Rohan said the national average hospital stay after a kidney transplant is five to seven days and typically two to three days at Northwestern, but because of the use of regional anesthesia, Nicholas’ was out within 24 hours of a major surgery.
Nadig said Nicholas’ kidney failure was “cured immediately” with a new, fully functioning kidney. Other than managing some mild discomfort with over-the-counter pain relievers, Nadig said Nicholas didn’t use any opioid narcotic pain medication post-surgery, another benefit to less anesthesia.
After the successful surgery, the team hopes to perform more awake procedures and help more people.
“I think this is an exciting new chapter, and I think it’s going to open up doors for a lot of new people to get kidney transplant and it’s also going to make our whole kidney transplantation process and the patient experience better,” Rohan said.
It seemed like a “no-brainer,” Nicholas said about participating in Northwestern’s first awake kidney transplant. He said his recovery has gone “extremely well” and is satisfied with his decision.
He added that his experience overall was “very interesting,” mostly because he was awake but also because after years and years of buildup and dealing with his kidneys giving out, his problem is “totally gone.”
“That was definitely a powerful, profound experience,” he said. “It didn’t actually hit me until I was in post-operative recovery how insane it is to think I have a third kidney, and I actually saw it.”
