My brother and I both had kidney transplants when we were teenagers, six days apart. That wasn’t how it was intended to be. He was slated to receive my father’s kidney in April 1998, despite being two years older. The transplant team completed its final blood panel twenty-four hours before the procedure and found a tissue incompatibility that all the earlier tests had mysteriously missed.
My brother was placed on “the list,” where he would have to wait for the kidney of someone who had passed away and had the kind foresight to be a donor after death, for an unknown amount of time. My turn to receive my dad’s kidney was next. We found each other, and the date of August 28 was scheduled.
Then, on August 22, early in the morning, my parents received a call. An automobile accident had occurred. There was a kidney for sale. Like many other things in life, my brother went first and I was right behind him.
His procedure was successful. It was my time six days later. Before the transplant, I recall going to the doctor and experiencing the pinprick and stinging flush of local anesthesia, followed by a dull pulling and the weird and sickening sensation of a dialysis catheter being removed from below my collarbone. As I was being rolled into the operating room, I later recall the calm midazolam fog.
After surgery, I can still clearly recall emerging from vast depths, shaking hysterically, and then dozing off again. I recall seeing a movie about an aircraft accident in the Alaskan bush with Anthony Hopkins and Alec Baldwin running from a huge grizzly bear while lying naked under blankets in the ICU and moderately delirious from morphine. I recall having people visit me while I was recovering and how painful it was to laugh.
However, after 24 years and being in generally good condition, I can see how much I’ve forgotten. I don’t remember the brief stint of dialysis from the months prior to my transplant: those enormous recliners hidden away in the taupe interior of a hospital where machines recycled and drained my blood three times a week.
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I no longer remember how bland a low-potassium, low-phosphorus, and low-salt diet is. I fail to recognize how odd it is that taking a few medications in the morning and at night keeps the foreign organ in my lower belly alive—and keeps me alive.
I sadly lose sight of the greatest gift I have been given—this unending period of extra time—while 90,000 other Americans wait for it, many spending years on dialysis in the meantime. Every year, about 4% of those who are still waiting will pass away, and another 4% will get sick enough to require significant surgery. However, I find myself forgetting this grace.
When my brother’s kidney started to fail five years ago, all of these long-forgotten memories came flooding back. His blood tests revealed inconsistent levels, worrying nephrologists. He had recurrent viral infections and was in and out of the hospital. A biopsy found necrotic tissue that was webbed throughout and punctured half of his kidney.
Finally, in May 2018, he wrote an email to his loved ones that summarised his two borrowed decades of going to concerts, hiking in the Pacific Northwest, falling in love, getting married, and starting a family. All of this information was provided in an amicably cheerful manner, but as every reader was aware, they were inevitably heading toward an unpleasant end. 37 years old, he was still in the
A deliriously ill Richard Herrick underwent THE FIRST SUCCESSFUL kidney transplant in Boston in 1954 with the help of his identical twin brother Ronald. Richard’s new kidney was still functioning when he passed away from a heart attack eight years later.
Before it, there had been sporadic attempts. In 1933, a type O-blooded 26-year-old lady in Ukraine received a kidney transplant from a 60-year-old type B man who had been dead for six hours. She had poisoned herself and had lost the ability to function her kidneys. Considering the available technology, it is incredible that the recipient lived for two more days.
circumstances at the time and public knowledge. In 1950, a transplant patient in Chicago saw temporary imMost patients passed away as a result of graft-versus-host disease, organ rejection, or both. The transplant surgery industry became isolated and hopeless. The more conservative doctors of the day condemned the procedure, citing the fundamental principle of preventing needless harm. A critic asked around this time, “When will our colleagues stop this game of experimenting on humans? When will they understand that passing away itself can be a mercy? improvement in kidney function. In the early 1950s, experimentation exploded in Paris. The Herricks then arrived.
Although their tale was technically brilliant, it failed to address the key biological conundrum of transplantation: how to control the immune system. Most of the time, when our bodies encounter foreign tissue, a battery of B and T cells is sent to kill it. The Herricks avoided this dilemma because they are identical twins with nearly identical tissue types.
But for kidney transplants to ever become a common surgery, surgeons would need to find a way to deal with our intrinsic immune response. Early attempts involved giving patients full-body, nearly deadly doses of X-ray radiation prior to surgery. The idea was to weaken the immune system and then allow it to recover after the new kidney had been inserted. A bone marrow injection might also have been given in conjunction with this.
Most patients passed away as a result of graft-versus-host disease, organ rejection, or both. The transplant surgery industry became isolated and hopeless. The more conservative doctors of the day condemned the procedure, citing the fundamental principle of preventing needless harm. A critic asked around this time, “When will our colleagues stop this game of experimenting on humans? When will they understand that passing away itself can be a mercy?