SURGEON'S DIARY: He donated one kidney to his mother but now remaining one has a tumour

Few years back, I wrote a story in this column about a son, who donated his kidney to his mother who suffered from kidney failure and was on dialysis twice a week. ILLUSTRATION| JOHN NYAGAH

What you need to know:

  • Her philosophical and pragmatic sermon failed to raise my spirits and as I walked to my office from the MRI department, rehearsing the speech I would have to give my favourite mother and son team, I had a brainwave, a rare phenomenon, lately!
  • Before seeing Josphat and his mum and give them the dismal news, arising from my discussion with the radiologist, I decided to ring the surgeon in the UK, who had carried out transplant surgery on them and ask him if he had any bright ideas.
  • After listening carefully to my problem, he shone a torch in the dark tunnel and said. “There is a pioneering trial going on at the Churchill Hospital in Oxford known as auto-transplantation.”

Few years back, I wrote a story in this column about a son, who donated his kidney to his mother who suffered from kidney failure and was on dialysis twice a week. This is a follow up on that case. The mother and son team went to England for the kidney transplant procedure, sponsored by the mother’s employer. On their return, the pair was under regular surveillance by the nephrologist – kidney specialist – and me, both involved in their initial management. As a rule, he organised blood tests to check their creatinine and urea levels, indicating their kidney function of excreting waste products and water, were within the normal range. In addition, he arranged an IVP, intravenous pyelography, to see that the anatomical configuration of their urinary tract was normal. IVP also gives an indication of the kidney function, by showing that the dye injected is excreted normally.

One fine morning the nephrologist rang me and said. “Our famous mother and son team is here with me on their annual follow-up and while the recipient is okay, the donor complains of haemeturea. Since his symptom is more in your line of work, I am sending him to see you while I carry out the usual investigations on the mother.”

“Please send him to me straightaway,” I said, considering that blood in the urine of somebody of Josphat’s age group is an ominous symptom, more so, when I knew that he only had one kidney. “I will ask my secretary to fit him between booked appointments. Please tell him that he might have to wait for long, but he will be seen today.”

Josphat and his mother were ushered in my office during my “sandwich break”, so called because I allowed myself a gap of 10 minutes to gobble my sandwich, which Marie packed every working day with a thermos of hot soup, the latter used by our daughter many years ago when she carried her packed lunch to Loreto Convent, Msongari. Instead of giving me my usual break, my secretary ushered in the mother and son.

I suspect it was her passive “avenge measure” for booking an extra patient on a busy morning, especially when she had warned me at the beginning of the session that she had a very tight schedule.

“I am told that you have seen blood in your urine.” I remarked after greeting the son and the mother. “How long has this been going on for?”

“I first noticed it a fortnight back,” replied Josphat. “Since my mum and I were due to go for our annual check-up soon, I waited until I saw Prof Ouko.”

“Is there any pain?” I inquired.

“No.” Josphat replied with obvious relief on his face, not realising that painless haemeturea at his age portends a serious disease like a kidney tumour.

I asked other relevant question, talked to the mother, who looked petrified and then examined Josphat. As expected, I did not find anything significant and ordered urine examination, an IVP and also MRI of the urinary tract. “I also want to see your urine myself,” I said to Josphat. “Do you think you could oblige now?”  I asked.  “Yes, I can,” he replied, getting out of his chair. “I will pick up a container from your secretary.”

As I waited for Josphat, I talked to the mother. “You have been alright since the transplant?” I asked her.

“Fine,” she replied. “In fact Dr Ouko told us that Josphat’s kidney was working more efficiently in my body than it did in his!” In a few minutes Josphat was back carrying a glass container covered with a white napkin and it contained bright red blood with hardly any urine.

The investigations confirmed my worst fears. Josphat had a malignant tumour in his solitary right kidney, the removal of which would condemn him to a lifetime of “twice a week” dialysis, precisely a situation, to overcome which, in the case of his mother, he had donated his left kidney to her. I took his MRI films to discuss with our radiologist, who measured the tumour and solemnly commented. “The growth is five centimetre by eight, making it surgically unsuitable for partial nephrectomy; in fact it is contra-indicated in a tumour of this size, located near the middle of the kidney.”

I was hoping against hope that I could remove the cancer stricken part and leave enough healthy kidney to carry out normal function and avoid dialysis. “Obviously nature has given us more kidney than we need and it is amazing how little kidney tissue we need to clear our waste products.” I said to my radiologist colleague.

“Unfortunately in this case, your surgery will leave some malignancy behind or leave so little healthy functioning kidney that you will not be able to avoid dialysis.” Looking at my crest-fallen face, she added. “I feel sorry for you because you have to tell this to your patient and his mother who is bound to feel very guilty for depriving her son of one of his two kidneys, given to us actually for this sort of contingency.”

Presumably, to take my mind off this grave issue, she continued: “There are many reasons, I specialised in radiology. It is easier to report on X-Rays than talking to patients. Also being a woman, I wanted a specialty where I could work during office hours and have time to look after my family.”

Her philosophical and pragmatic sermon failed to raise my spirits and as I walked to my office from the MRI department, rehearsing the speech I would have to give my favourite mother and son team, I had a brainwave, a rare phenomenon, lately!

Before seeing Josphat and his mum and give them the dismal news, arising from my discussion with the radiologist, I decided to ring the surgeon in the UK, who had carried out transplant surgery on them and ask him if he had any bright ideas. After listening carefully to my problem, he shone a torch in the dark tunnel and said. “There is a pioneering trial going on at the Churchill Hospital in Oxford known as auto-transplantation.”

I was so excited and enthused by this development about which I had read in the surgical journals without realising its full significance that I decided to let him talk without interrupting him as he went on.

“The trial involves temporarily taking the kidney out of the patient’s body and immersing it in ice cold saline. At this temperature, the kidney can survive for up to 30 hours outside the body, giving enough time for the surgeon to work on it without hurry. This technique has two advantages, which are that the tumour can be removed meticulously and it is a bloodless procedure because the kidney is disconnected from its blood supply. This also allows extensive excision of the malignant tissue and satisfactory repair of the kidney.”

“Amazing!” I exclaimed.

Ignoring my astonishment, he continued: “The kidney is then returned to its owner and after a couple of sessions of dialysis, it kick-starts into action. That way the kidney is free of tumour and back to full function.”

“How long has the trial been going on for and what are the results?” I asked.

“For five years and the follow-up results are as good as they are in cases where the kidney is removed. And in cases of solitary kidney, as is the case in your patient, 85 per cent have been able to avoid dialysis,” he  replied.

“Can my patient avail of this technique?” I asked a question I was itching to ask since this telephone conversation commenced.

“Well yes. Many Kidney Units here, including mine, are taking a cue from the Churchill in Oxford and are starting their programmes. I started mine a year ago and have a few patients who have joined the trial. Since our unit dealt with your patient initially, I see no objection in him joining the trial. The more the merrier!” He concluded on a hearty note.

Then he added the cautionary corollary: “If Josphat is part of the trial, you as his surgeon have to give an undertaking that you will keep him under surveillance, do his blood tests, MRI of his urinary tract and other tests, ordained by our research team and send the results to them periodically.”

“I will do it willingly because it will help my patient and also the research project,” I assured him.

I told my secretary to call Josphat and his mother and give them an urgent appointment to see me. Soon the couple arrived in my office and after diagrammatically explaining the surgical difficulties to eradicate the disease and still keep it adequately functional, I triumphantly laid out my plans. I thought the pair would jump with joy but instead the mother reminded me: “You probably have forgotten that the bank, my employer, financed our travel and medical expenses. Josphat is not their employee; they might not extend funds from their CSR, corporate social responsibility.”

“We could do a Harambee.” Josphat suggested.

“How long will that take?” I asked   

“May be a month,” replied the mother.

I gave the matter a little thought and said: “As the lawyers say, time is of the essence. I suggest you take a loan from your employer and pay back after the Harambee.”

It is two years since Josphat came back after his innovative surgery. He does not need immune-suppressive drugs because it was his own kidney which was transplanted into his body. The bank loan has been partly paid and partly written off and Josphat’s solitary kidney function is satisfactory. Long may it last!