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Stanford Report, February 2, 2000

Former patient reflects on transplant operation, 35 years with mom's kidney

BY KRISTIN WEIDENBACH

Inga Goodnight's kidney was working just fine when she checked into Stanford Medical Center to have it removed. Carrying it carefully into the next room, a team of surgeons stitched it into her 27-year-old son and hoped that it would save his life. Thirty-five years later, Gary Goodnight and his 84-year-old mother rarely think of the kidneys that they share, but Gary's Christmas visit from his home in London gave mother and son occasion to reflect on their place in medical history.

Gary's 1965 operation was the third human kidney transplant done at Stanford, which was the first hospital on the West Coast where surgeons performed the procedure. Last year, 127 people received a new kidney at the Medical Center.

The late Roy Cohn, MD, who was a Stanford professor of surgery, and his team had first transplanted a kidney between identical twins in 1960 and followed up with a mother-to-daughter transplant in 1964. The world's first successful human kidney transplant between identical twins was performed at the Peter Bent Brigham Hospital in Boston in 1954.

The development of immunosuppressive drugs first allowed transplants to be successfully attempted between family members who were not identical twins. Later, advances in immunosuppressive therapy allowed transplants even between unrelated people, and immunuosuppressive drugs like cyclosporin are still the mainstay of transplant recipients today. Gary Goodnight has been taking an immunuosuppressive drug called Imuran since he received his new kidney.

In 1965, kidney transplantation was considered a risky and experimental procedure. It was approved only for "terminal" patients who were believed to have no other means for survival. "It was a last resort operation," said Gary. "[The doctors] didn't tell me, but they did tell my family that it might buy me an extra year," he said.

Gary's kidneys had been damaged by glomerulonephritis. His kidneys stopped filtering waste from his blood and failed to excrete fluid from his body in the form of urine. At eight years old, Gary was admitted to an Indianapolis hospital where he stayed for a year. "Essentially they put me in there to die. I was like a big water balloon ­ all flat on one side from lying in bed," he recalled.

A move to Arizona's hot, dry climate resulted in a dramatic improvement in Gary's health. His kidneys functioned normally for the next 15 years but then began to fail, adhering to his doctors' predictions. It was 1964.

"I started to deteriorate. I was turning green because I was so toxic. [The doctor] said, go check yourself into Stanford, we've got to do a transplant," Gary said.

Unbeknown to him, members of his family had already been tested to see if any would be a compatible kidney donor. His mother, Inga, was found to be a good match and preparations for the transplant proceeded. Gary's kidneys were removed and he underwent dialysis for two weeks to cleanse him of the toxins that had accumulated in his body.

The day of the transplant, both Gary and his mother were prepared for surgery. General anesthetic was still considered quite dangerous at the time, and Gary's doctors did not want to risk it so he was given a spinal block and remained awake throughout the operation. When the kidney was removed from his mother in the adjoining operating room, Gary asked to see it before it was inserted. "Cohn said, 'For God's sake knock him out. He's driving me crazy!' " Gary said with a laugh. "I was asking too many questions."

The operation was a success and Gary's doctors were thrilled that his new kidney began producing urine right away. He experienced no episodes of rejection, and his mother's kidney has served him well for the past 35 years. Likewise, Inga has had no deleterious effects from the transplant operation. "I just had a physical and they said the kidney was fine," she said.

Compared to the seven days that today's kidney transplant recipients typically spend in the hospital, Gary's two- month-long inpatient recovery time was lengthy, but he believes that he was probably kept in the hospital so long because it was a learning experience for the doctors and nurses.

"I was up and around and fine, but it was a big deal for them and I became kind of the pet of the hospital," he recalled. "I didn't like hospital gowns, didn't want to wear pajamas and they wouldn't give me street clothes, so the interns would sneak in surgical gowns and I'd put a stethoscope around my neck and go on clinical rounds with them," Gary said with a laugh. "I'm sure every one of them would deny it to this day," he quickly added.

Gary also remembers that a kidney was transplanted between two dogs at the same time that his operation was conducted to serve as a control. "At the time, there was a lot of guesswork involved," he explained. "Based on the body weight, they were medicating the dog as a control on me. So I'd go down and visit 'my dog,'" Gary said. These visits continued until one day he went to the animal house and was told that his dog had died.

Fortunately for the Goodnights, Gary escaped such a morbid fate. "Before the transplant I was so sick that I was at the point I didn't care. I was thinking, 'just let me sleep or die,'" he recalled. "After the operation, I felt fine for the first time in years." SR