My brother’s kidney keeps me alive

Forget lofty phrases, poetry even. Nothing manifests love like an act of sacrifice — that gesture of putting your life on the line for someone else.

We witnessed such a sacrifice recently. Actually, a four-hour surgical operation when Major Omar Aboud, 27, donated a kidney to his brother, Aboud Said, 37, who had suffered kidney failure
Malfunctioning kidneys kill thousands of Kenyans every year due to a combination of poverty, the sheer complexity of organ transplants, and the law, which is meant to guard against illegal harvesting and trading in human organs.

Seven days ago Omar and his brother faced the surgeon’s scalpel at the Kenyatta National Hospital. We documented the procedure, right from admission to their discharge from Kenya’s largest referral hospital.

As the brothers prepared for the operation on a Tuesday evening, family and friends were at their bedside to offer psychological support ahead of the procedure, which is carried out once every fortnight at the giant hospital.

For 37-year-old Said, the kindest gesture was that his youngest brother donated his kidney to him when doctors established that their organs would match. Said’s wife and another brother, Ismail Omar, had also been tested as probable donors but did not meet all the requirements.

“My problems started in 2003 when I was diagnosed with high blood pressure, which worsened when my kidneys failed in 2010,” says Said.

On the big day, the donor transplant team comprising Prof Ngugi Mungai, a urologist, Dr Maina Kanyi, Dr Thomas Chokwe, and Dr Carol Mwangi and anaesthesiologists were all in Theatre Three.

Anaesthesiologists specialise in administering drugs that make patients lose bodily sensation during surgery. This can be achieved with or without loss of consciousness.

The anaesthesiologist, Dr Charles Kabetu, and the cardiovascular surgeons, Dr Josiah Ruturi and Dr James Munene, were in the recipient transplant team in the adjacent Theatre Six.

The operating team and the DN2 reporters scrubbed as Omar was wheeled into Theatre Three at 9am. Nurses distracted the patient with conversation to ease his anxiety as the other theatre staff prepared the equipment.

“Are you nervous?” one of the theatre nurses asked him.

“If I was, I wouldn’t be doing this for my brother,” he replied.

Minutes later, Prof Mungai, who also teaches at the University of Nairobi’s School of Medicine, emerged from the theatre to explain to Omar the procedure. He showed him where he would make the incision on his left side to remove the kidney that would later be transferred to his brother, who was waiting in the theatre across the hall.

After ensuring that Omar understood what the operation entailed, Prof Mungai left to scrub for the surgery.

At 9.45am, Omar was wheeled into the theatre, where he was received by the anaesthesiologist, Dr Chokwe, and Dr Mwangi, who explained to him the procedure of anaesthesia. In less than a minute, Omar was unconscious.

The theatre staff placed him in the left lateral position to facilitate access to the kidney to be harvested. Also in the operating room were Fifth Year medicine and surgery students and anaesthesiologist trainees.

Prof Mungai thoroughly cleaned the operating area — the left side of Omar’s abdomen — using an antiseptic solution to ensure that the skin was safe for the surgical procedure and also to reduce chances of infection through bacteria.

The patient was then draped in clean scrubs to preserve his dignity. The operation site was covered with sterile drapes to keep the incision clean.

Prof Mungai called out to the team to check if it was ready for the operation to begin. Once the team replied in the affirmative, he used a scalpel to make a 10-centimetre incision below the rib cage, marking the beginning of the four-hour surgery.

Next, he went through the connective tissue that surrounds the muscles before getting to the first layer of muscles known as the external oblique.

For the next three hours, there was a lot of medical jargon and at one stage Prof Mungai summoned the trainees and journalists to approach the operating table to have a look at Omar’s kidney shortly before it was removed.

The ureter (one of two thick-walled tubes that carry urine from the kidney to the urinary bladder) was also exposed and taped before the surgeon clamped and cut it. He followed it to the kidney and separated the latter from the surrounding fats and tissues. Prof Mungai then identified the blood vessels to the kidney.

All this time, Dr Chokwe and his team monitored Omar’s heartbeat and other vital signs.

Prof Mungai explained that the donor’s kidney was almost ready for harvesting and was only attached to Omar by an artery and a vein. The team in the adjacent theatre, led by Dr Munene, was alerted that the harvesting was almost over.

The team, which would work on Said, the recipient, gave the thumps-up: they were ready. Said was already under anaesthesia and ready to receive his brother’s kidney.

He lay flat on his back and had a 15-centimetre incision made in his right pelvic area. The incision was bigger than Omar’s to facilitate easier transplantation of the kidney.

Prof Mungai’s team went ahead to harvest the kidney and place in an ice-filled tray where perfusion — the process of preserving an organ outside the body by pumping fluid into it — was performed and the kidney cooled to 4°C.

When the donor kidney was transplanted into Said’s right lower pelvis, the vessels of the new organ were connected to the vessels leading to the right leg and the ureter was joined to the bladder.

Once the clamps were removed, blood circulated through the new kidney and it turned pink and began to function immediately.

In most cases, the recipient’s native kidneys are left in place. The transplanted kidney performs all the functions of both organs in healthy people.

Omar was discharged three days after the procedure, while his brother spent another week in hospital for observation.

Said had been on a special diet prescribed by nutritionists seven months before the operation. He had been undergoing dialysis twice a week since 2010. The procedure cost Sh4,500 at Kenyatta, but was much more expensive is private hospitals.

According to Dr Munene, a successful kidney transplant gives one increased strength, stamina, and energy.

“You should be able to return to a more normal lifestyle and have more control of your day-to-day activities and take up a normal diet and fluid intake,” said Prof Mungai.

However, Said will be required to take medication for the rest of his life to ensure that his body does not reject the transplanted organ. The generic drugs cost about Sh20,000 a month and the branded ones Sh30,000.