Transplant extends Lawrence man's life

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Friday, Apr. 10, 2009

Transplant extends Lawrence man's life

By KARREY BRITT - Lawrence Journal-World

LAWRENCE, Kan. -- Logan Hastings signed up to be an organ donor as soon as he got his driver's license.

He's always been a believer in giving the gift of life.

He just never dreamed that he would be on the receiving end, especially at age 26. He was athletic and had only been in a hospital once for a broken arm at age 8.

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"I was playing softball one night and ran to first base and could barely breathe," Hastings said.

That was a Friday.

On Monday, the auto mechanic put a transmission in a Jeep and then decided to go to PromptCare, a walk-in clinic. Doctors ran a couple of tests and immediately sent him to Lawrence Memorial Hospital's emergency room. That's where he was diagnosed with chronic kidney failure.

The kidneys remove toxins and excess fluid from the blood and put them into urine, which is expelled from the body. When the kidneys don't function properly, the fluids and toxins can accumulate in the body.

Dr. Scott Solcher, a Lawrence nephrologist and Logan's doctor, said his kidneys were filtering essentially nothing.

"His was absolutely end stage," Solcher said.

Logan was immediately put on dialysis, an artificial means of doing what the kidneys are not doing.

The most common causes of chronic kidney failure are diabetes and high blood pressure. But Logan didn't have either of those. Solcher said Logan's case was unusual and could have happened for a number of reasons. For example, it could have been a virus.

"By the time he showed up, his kidney function was so bad that we won't ever probably figure it out," Solcher said.

The doctor said Logan's kidneys had been failing long before that day, but didn't show symptoms until that weekend because he was so healthy.

"If you are young and healthy, you can tolerate a lot of toxins before you feel bad, and that is what happened to him."

Logan was hospitalized for three days and then sent home. His condition required time-consuming dialysis until he underwent a kidney transplant.

There are two kinds of dialysis. The most common is called hemodialysis, where people visit a dialysis center about three times a week for four hours each time. During the visit, a machine and filter are used to clean the blood outside the body and then return it.

Logan opted for peritoneal dialysis, which is a home therapy that offers more flexibility but is a daily process. Solcher said only about 10 percent of Americans who do dialysis opt for peritoneal.

In peritoneal dialysis, a special solution is entered into the abdominal cavity and all the toxins flow into the solution. Logan needed to insert two liters at a time, so it gave him a sensation of being full, but he said it wasn't uncomfortable or painful.

"You couldn't tell really," he said.

During the day, he would put the solution inside of his stomach and then after several hours drain it. At night, he hooked up to a machine that did the process for him.

"The dialysis doesn't make anybody's kidneys any better; it just replaces their function and by and large it keeps them feeling pretty good," Solcher said. "It is a lifestyle change for sure because it entails a lot of time."

Logan had to cut his calcium intake, which was difficult for someone who consumed about a gallon of milk a day. But he made the switch to water. He also weighed himself about five times a day to make sure his fluid levels were on target.

In the meantime, Logan went on disability, earning about $900 per month, because he wasn't supposed to lift more than 25 pounds and wasn't feeling well. He also didn't have health insurance. So far, Medicare and Medicaid are paying for his health care costs.

Logan joked about how he was "lucky" to have chronic kidney failure, a disease that Medicare picks up for people under age 65.

Family and friends were tested to see whether they could donate a kidney.

"It was kind of frustrating," said Logan's mother, Sharon Baldwin of Chanute. "Of course with diabetes and high blood pressure on both sides of his family, his family members weren't really able to donate a kidney to him. That was pretty frustrating on everybody's part, I think."

Logan was added to the national transplant list one year later. Not only would a transplant improve his quality of life, but he likely would live longer.

"It is very well known that people on dialysis have a lower survival rate when it's compared to patients who receive kidney transplants," said Dr. Ahmad Bashar Abdulkarim, director of solid organ transplantation at Kansas University Hospital.

The third time was a charm for Logan.

He endured two calls from University of Kansas Hospital. Both times he was the backup for transplantation if things fell through for the first person on the list.

His call finally came at 3 a.m. Dec. 29 and Logan slept through it. He checked his messages at 8 a.m. and immediately called the hospital back. He was to be at the hospital by 10 a.m. - don't drink or eat anything, he was told.

"That was hard," he said.

Logan didn't go into surgery until 9:30 p.m. and he found out that he would be receiving a 3-year-old's kidneys. The surgeon transplanted both kidneys and the main blood vessels into one side of Logan. Such a procedure is fairly rare. Of the 95 kidney transplants last year at University of Kansas Hospital, only three or four involved a child's kidney being used in an adult.

Abdulkarim said the approximately four-hour surgery requires a significant amount of training and expertise because the surgeon is working with such small organs and blood vessels. He said the risks are about the same as transplanting an adult kidney, maybe a little higher.

"It requires a lot of experience as to how to lay these two kidneys next to each other," he said. "You can't stack them. They have to lay down exactly the way they are placed in the donor's body. You lay them down and then engineer exactly where the junction of the donor vessels and the recipient's vessels is going to happen."

University of Kansas Hospital has been performing organ transplants since 1969, but only has been doing this one - called an en bloc transplantation - for the past five years. Doctors said the procedure helps utilize more organs.

"As long as the size of the waiting list is getting bigger nationally, we are getting more and more aggressive in our approach to get valued organs to people on the waiting list," Abdulkarim said.

There are 110,000 people waiting for a lifesaving organ transplant, and 83,000, or 75 percent, need a kidney.

Logan was released from the hospital eight days later and has made a full recovery.

"He's doing great," Dr. Atta Nawabi, his transplant surgeon, said. "I think that kidney is going to grow up and it's going to live longer than the kidneys that come from older people."

Logan no longer has to do dialysis, and the only dietary restriction is grapefruit and grapefruit juice, because it affects his anti-rejection medication.

"I feel about 100 times better. I can actually walk up the stairs without losing my breath," he said. "It's different than I've felt in three years."
Information from: Lawrence Journal-World, http://www.ljworld.com

http://www.bnd.com/336/story/724309.html