Surgeons at Northwestern Medicine Comprehensive Transplant Center have successfully performed their first kidney transplant on an awake patient.

Northwestern Medicine. Northwestern Medicine surgeons perform awake kidney transplant with next day discharge. June 24, 2024.

It is believed to be the first such transplant in the United States.

Interesting Engineering. Photos: US’ 1st awake patient kidney transplant with next day discharge. July 1, 2024.

Kidney transplant patients typically undergo general anesthesia, which sedates them for the surgery. Widely used, general anesthesia can keep patients numb during lengthy and invasive procedures. However, general anesthesia is not without risks; it can be dangerous for people with severe heart or lung issues—among other conditions—who may be susceptible to arrhythmias after the procedure or not wake up afterward. Additionally, following a kidney transplant with general anesthesia, patients stay in the hospital for an average of 2 to 2 days, according to Northwestern Medicine.

Northwestern Medicine. Northwestern Medicine surgeons perform awake kidney transplant with next day discharge. June 24, 2024.

One noticed benefit was the patient’s recovery time, which was significantly shorter than that after a general anesthesia transplant. Rather than spending multiple days in the hospital following the operation, the patient was discharged the next day, “basically making this an outpatient procedure,” transplant surgeon and director of the Northwestern Medicine Comprehensive Transplant Center, Satish Nadig, MD, PhD, said in the press release.

The future of kidney care

Amit Kapoor, MD, Chief Nephrologist officer at Strive, a kidney care company, calls Northwestern’s recent success “groundbreaking,” and says that it has promising implications for the future of kidney care. Dr. Kapoor was not involved in the recent transplant.

“The benefit of this is [that] it opens up the number of patients who could get a kidney, where previously the general anesthesia would be a roadblock or a barrier,” Dr. Kapoor says. “That’s where it becomes an exciting opportunity.”

While spinal anesthesia methods may increase kidney transplant opportunities for some, Dr. Kapoor reminds people that it can’t break down the biggest barrier to these procedures: a shortage of organs.

“Having this procedure doesn't mean we get more kidneys available, unfortunately, and that’s always been our limiting step,” he says. “The advantage is now we'll be promoting more of our patients, even our older ones or ones with underlying heart or lung problems, as eligible to get a kidney.”

Following its success, Northwestern Medicine says that it has plans to establish a special kidney transplant program for procedures during which patients will be awake. This will be known as the Accelerated Surgery Without General Anesthesia in Kidney Transplantation (AWAKE) Program and will be designed to serve “particular subsets of patients that want the operation, can’t have general anesthesia or have a high-risk of general anesthesia, or fit into a category where this could benefit the patient,” according to the press release.

Reserving spinal anesthesia for certain populations seems like the right move for now, Dr. Kapoor says. This is because general anesthesia remains the mainstay for kidney transplants and can be effective at safely delivering the surgery. Additionally, more transplant surgeons are likely already trained on how to safely and effectively perform this method of surgery. Proper training is important, as, like general anesthesia, spinal anesthesias do not come without risks. For instance, the placement of spinal anesthesia can make recipients more vulnerable than general anesthesia recipients to nerve complications, among other issues.

“The fact that we potentially have a viable [anesthesia] alternative that's less intense [and] just as effective and [that] allows these [high-risk groups of] patients to get a kidney, I think that's where the real opportunity comes,” Dr. Kapoor says. “I think it'll be good and, in certain cases, for our patients.”