Transplant rids couple of ‘shadow'

Published: December 30, 2007 6:00 a.m.

Transplant rids couple of ‘shadow'
Local patient celebrates kidney

By Michael Schroeder
The Journal Gazette

Next stop: Mall of America.

Now that her husband has a new kidney, Tabitha Donovan, 34, hopes the couple can take a trip to Minnesota. She’s always wanted to go to the most famous mall in the U.S., but scheduling conflicts with Aaron’s dialysis made such a trip seem out of reach.

Not anymore.

Relaxed travel constraints are the icing for the Donovans since Aaron, 36, underwent a second kidney transplant in September. The cake is the promise of possibility, where once fear of the unknown consumed them.

Looking a little like newlyweds, the couple, who have been married 11 years, were practically bubbling during a recent interview at their home in Garrett. Aaron’s change of fortune, evident in a flush of color that’s returned to his face, fueled talk about his continued studies at Indiana University-Purdue University Fort Wayne, plans for steady work, exercise and renewal in other areas of his life previously disrupted by health issues.

“You don’t have this huge shadow hanging over your head,” he said.

Donovan has had kidney disease his entire life, the result of a genetic condition. The disease causes gradual and usually permanent loss of kidney function over time. The kidneys eventually stop doing what kidneys were designed to do – remove waste and excess water from blood.

In 1990, Donovan underwent his first kidney transplant at the Indiana University Medical Center in Indianapolis. He was told his new kidney would be functional for 10 to 12 years. True to estimates, it lasted 11 years – providing some welcome relief during that time. In 2001, dialysis became his lifeline.

Donor kidneys are considered the gold standard in treating kidney disease, but with more people in line for a kidney than any other organ, many patients turn to dialysis. Donovan underwent regular four-hour treatments where a dialysis machine filtered toxins from his blood. But complications turned his attention back to kidney transplant.

For three years, he was on the waiting list for a kidney. Twice he was on death’s door from complications related to kidney disease. On one occasion, he’d gone into septic shock and doctors didn’t know if he’d make it through the night, his wife recalls.

“My heart sank in my stomach and I just felt like I was going to be sick … knowing I was going to lose him.”

She didn’t, of course, but the stress and worry lingered.

Finally, the call came at 2 a.m. Sept. 20 that he had a match from a deceased donor in Indianapolis. Twenty-two hours later, he underwent surgery at Lutheran Hospital, the sixth transplant patient in a new program at the hospital.

He spent two weeks in the hospital, much longer than is typical for transplant patients. Thirty-six years of kidney disease increased the risks involved with transplant for Donovan and he knew it might be a bumpy ride.

At first his new kidney didn’t work; it wouldn’t produce urine. He began to swell with fluid until efforts to get it going eventually paid off. He went home; then returned to the hospital for four days after powerful anti-rejection drugs started to shutdown his new kidney. He spent another two days at the hospital after his blood pressure dipped.

Despite those hang-ups, things are going well now for Donovan, who lauds staff at Lutheran Hospital for their care and talks about the ordeal with the perspective of one who’s weathered his share of storms.

“I’d had a lot of blood clots, a lot of vascular problems,” he said, describing his days on dialysis before the transplant. He’d had issues with extremely high blood pressure and extremely low blood pressure.

“It was always a struggle.”

Some days he didn’t want to get out of bed. A junior this spring at IPFW, he spent his two previous spring breaks getting treatment at Lutheran Hospital. He dealt with physical limitations and had trouble holding down steady work.

“I knew how much was at stake with this transplant.”

So did his doctors.

“We do the best we can with dialysis but it’s not as good as having your kidneys function,” said Dr. John Ducker, a nephrologists at Indiana Medical Associates who worked closely with Lutheran Hospital in the development of its kidney transplant program.

Donor kidneys typically remain functional for 15 years, though every case is different and much depends on a patient’s health. It’s not altogether uncommon for a patient – especially one who got a transplant at a younger age – to need a second transplant later in life, Ducker said.

In part, that’s because the underlying disease is still there, he said. So are problems often associated with kidney disease, such as high blood pressure and diabetes. What’s more, the very medications that patients take to ensure acceptance of the donor organ can undermine kidney function. Compliance issues – doing what the doctor says to preserve the kidney – are often to blame for kidney function problems as well, although that wasn’t the case with Donovan, Ducker said.

Given Donovan’s age when he received his first kidney, it’s hardly surprising he underwent a second transplant. And it’s highly probable that he could someday undergo a third.

But he’s glad he didn’t get an estimated forecast for how long his new kidney is expected to function. He’s got other things to think about, including his studies. He’s going to school for health care administration and he signed up for some pre-law classes.

“I actually have a passion for Indiana’s organ donor law,” Donovan said.

He’d like to overhaul the law to make it easier for more Hoosiers to donate their organs. He’d also like to secure a full-time job, something he hasn’t been able to do with previous health problems. He’s even thinking about entering the National Kidney Foundation’s U.S. Transplant Games this July in Pittsburgh, probably in cycling.

Then, perhaps, it’s on to Mall of America. That would be a good trip to make next November, he said.

mschroeder@jg.net

The program
As of Dec. 25, 17 kidney transplants had been done at Lutheran Kidney Transplant Center since the program’s inception in June. Thus far, none of the transplanted kidneys has lost its function and overall, patients have fared well, said Margaret Scatena, executive director of cardiac and vascular services at Lutheran Hospital.

The program’s goal next year is 40 transplants. About 50 patients are on the waiting list for kidneys locally.

A transplant costs, on average, about $105,000 , though price varies by case. Private insurers cover the transplants to varying degrees. The program isn’t yet certified by Medicare, and until that happens, it’s expected that only some of the private insurance companies will provide the maximum benefit. Medicare is expected to make a site visit to consider certification of the program – a precursor to coverage by the governmental insurance program – in the next few months.

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