HOUSTON — Michael Wingard arrives at Houston Methodist Hospital with a cheery “Howdy!” He’s a slender young man with a shaggy beard and a healthy left kidney that was where it always was – tucked safely just below his rib cage.
In a few hours, a surgeon will remove the kidney and sew it into someone else’s body.
This is also the day before his 20th birthday.
“I hardly think about it,” Michael tells NPR. “Unfortunately no cake. It’ll be like jelly or something.”
The Wingard family hails from Kerrville, Texas, about four hours west of Houston. Michael’s parents, Adrien and Ed, are with him and they burst into tears as Michael is checked in.
“I’m very, very nervous and scared and all these emotions, but I’m so proud of him,” says Adrien Wingard. “He knew his friend needed a kidney and he had to do whatever it took to make it happen.”
A chain of life
However, Michael Wingard’s kidney does not go to his girlfriend because he was no match for her. But he was a match for someone else.
And so Wingard became the first link in a 10-person chain held at the Houston Methodist earlier this month.
In addition to Wingard, the swap included:
- Heather O’Neil Smarrella, who will have his kidney. Then her twin
- Staci O’Neil gave her her kidney
- Javier Ramirez Ochoa, his son-in-law
- Tomas Martinez, donated a kidney to
- Chris McLellan, his father
- David McLellan, gave him his kidney
- Barbara Moton, their daughter
- Lisa Jolivet, gave her her kidney
- Kaelyn Connelly, Wingard’s girlfriend.
This 10-person process takes place over four days and is unusual. The last at Houston Methodist was in 2020. Normally, the hospital has chains involving up to six people.
For all its complexities – from matching antibodies to patient health – a kidney swap of this magnitude is difficult to accomplish. This was postponed three times.
But it’s worth it.
There are about 90,000 people awaiting a kidney on the organ procurement and transplant network’s list. Many will remain on the list for years. Some die waiting.
Transplanting kidneys from living donors significantly increases the number of kidneys available. In addition, a living donor’s kidney functions for an average of 12 to 20 years, while a deceased donor’s kidney functions for around 8 to 12 years.
Alternative to “dialysis or death”
dr Richard Link, Michael Wingard’s surgeon, arrives a few hours after Wingard checks in to explain that the surgery will be laparoscopic; He will remove the left kidney through a 2 inch incision in the abdomen. dr Link describes this as a relatively routine operation.
“You’ll be surprised that we can get a kidney out of the hole we’re making,” he says. “It’s a bit like a magic trick.”
When a nurse comes to take Michael Wingard to the operating room, his parents hold hands.
“Rock it, mate,” his father says in his ear.
As Wingard is wheeled down the hall, Heather O’Neil Smarrella is preparing to receive his kidney and Lisa Jolivet is getting ready in her room.
The 43-year-old from Houston has an easy, infectious laugh. Even though it’s the night before her surgery, she jokes about jelly, the Astros, and “crap” kidneys. Jolivet is here because her mother, Barbara Moton, who loves casinos and her grandchildren, found out in 2019 that she was suffering from kidney failure.
“She kind of said, ‘This is my destiny. These are my cards,’” says Jolivet.
Before Moton arrived at Houston Methodist, her doctors told her she had only two choices: dialysis or death. Her daughter refused to accept this and researched a third option: a living-donor transplant. She made a pinky vow to her mother.
“If you get rejected, we will never say anything about it,” Jolivet told her. “You don’t have to do dialysis and you can just ride into the sunset.”
But Moton passed all the tests and was approved for a kidney transplant in August 2021.
“I’m so ready to breathe out,” says Jolivet. “It’s been a long, long wait.”
NPR was hospitalized for most of the 10 surgeries. Each one was amazing and complicated, but it’s routine for surgeons. You know all stops, junctions and shortcuts. The territory within a body becomes familiar.
dr Link, Michael Wingard’s surgeon, cuts through the skin and tissue around the muscles and towards the left kidney. He controls the surgical instrument called the laparoscope, equipped with a tiny light and camera to guide the incisions made with a harmonic scalpel, cutting and cauterizing in the same disc.
The journey to the left kidney is captured in 3-D imagery that enhances colour, and the gaze is otherworldly and inward-looking. The spleen looks like a smooth pink bean. The stomach walls are light pink and ivory whorls.
As promised, Dr. Link Wingard’s left kidney from his body through a slit about the width of the rim of a credit card. He calls the organ “inconspicuous” – and means that as a compliment.
dr A. Osama Gaber, director of the Houston Methodist transplant program, sits ready before a silver bowl filled with crushed ice. He takes the fist-sized organ, rinses it off and puts it in the bowl. The crushed ice will begin to melt and turn the color of a squishy watermelon.
When the kidney has cooled sufficiently, Dr. Put them in plastic bags with ice and put them in a plastic bucket. He makes his way down the hall and takes the organ to another operating room, where Heather O’Neil Smarrella is waiting.
dr Gaber sews it up in front of her lower abdomen, and when the kidney’s ureter is connected to the bladder, a few drops of urine squirt out.
dr Gabriel laughs. He is delighted that Wingard’s former left kidney is now O’Neil’s. And it works.
“Apparently I peed on the table as soon as he plugged it in,” Smarrella says the next day.
She’s a little embarrassed at this, but mostly happy. She woke up that morning feeling better than she had in a long time.
Before, “it was a struggle to even get in and out of bed and get through the day,” she says.
She suffered from back pain, fatigue and memory problems. But now she only feels the pain of her incision.
“I feel 100 percent better,” she beams.
A “whip saw” diagnosis
“Everyone who makes it to our clinic has been through so much,” says Dr. Gaber. “They’ve learned that organ failure, whether it’s liver, kidney, heart or lungs, will kill them. It almost completely destroys their quality of life. The cost, the back and forth between doctors and diagnoses, and the loss of hope.”
dr Gaber, who graduated from medical school in 1976, was initially not a proponent of living organ donation. Early in his career, success rates were low and he felt there should be enough deceased donors.
But there isn’t, and over the years he’s changed his mind.
dr Gaber and his wife Lillian also built Nora’s home to help transplant patients. It is a center on the grounds of the Texas Medical Center where families can stay. It is named after his daughter who was an organ donor.
“She was seven and a half years old and we lost her in a car accident,” says Dr. Gaber. “I now know how to respect and appreciate these people who donate organs for others.”
A portrait of Nora hangs in his office. It shows a little girl with dark hair holding a sunflower.
Today, Houston Methodist performs about 700 transplants a year: kidneys, livers, hearts and lungs. And the success rates are much higher today.
“After doing this for so many years,” says Dr. Gaber, “I can tell you that it is changing people’s lives to an extent that is almost impossible to describe.”
Two days after Michael Wingard’s kidney surgery, a group of strangers gather in a hospital conference room.
Michael Wingard, Kaelyn Connelly, Heather O’Neil Smarrella, Staci O’Neil, Lisa Jolivet, Javier Ramirez Ochoa, Tomas Martinez and Chris McLellan sit around a conference table. Family members and doctors hover on the periphery.
And then they are no longer strangers.
Smarrella’s family gives Wingard a stuffed animal that matches one she carries around.
Chris McLellan leans over to Tomas Martinez: “Thank you for giving me my life back.”
And he adds: “You have a great kidney.”
Only Barbara Moton and David McLellan are not in the room to meet. You’re just out of surgery.
dr Gaber tells Lisa Jolivet that her mother’s surgery went smoothly. Lisa folds his hands and tearfully thanks him. She looks at Kaelyn Connelly – who received Jolivet’s kidney the day before.
“It’s surreal. I mean, we’re all different ages, different circumstances,” says Jolivet. “Just to be able to extend their lives is just incredible…the fact that we’re all going through this together is unreal.”
As the group disbands, some stay in the hospital and others go home.
Michael Wingard and his family make the four-hour drive back to Kerrville.
His parents say that this time he can ride shotgun.
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