Transplant reflects surgical leap in S. Dakota

SIOUX FALLS, S.D.  — A reunion of two friends recently brought new meaning to the notion of giving and receiving.
Ben Ekrem needed a kidney.
Mary Crandall gave him one.
They met in the 1990s, when Ekrem and Crandall’s husband, Doug, worked together in the insurance business in Sioux Falls. They and their spouses met again Tuesday at Avera McKennan Hospital to take part in a medical oxymoron — a routine life-saving procedure. Wednesday morning, Crandall was asleep on an operating table, where surgeons removed one of her kidneys. They stored it in a bowl of crushed ice and walked it next door to another operating room, where Ekrem waited to receive it.
Ekrem and Crandall thus took their place in medical history. They were transplant number 995 at Avera McKennan. Doctors there expect to reach 1,000 in a few weeks.
The milestone might rate someday as a footnote to the two friends’ experience. But to Ekrem, age 51 and a diabetic for 30 years, it was about liberation from four-hour sessions on a dialysis machine. To Crandall, 48, giving up a kidney was a matter of being a good citizen in the human family.
“Do you know the expression ‘to pay it forward’?” Doug Crandall said of his wife’s decision.
Avera McKennan has transplanted 604 kidneys since 1993. It added bone marrow to its transplant lineup in 1996 and has done 359 of those procedures.
It added the pancreas in 2003 for 32 more.
“We’re the first program in the state. We’ve got a good track record and so, for us, we’re pretty proud of it,” said Dr. Robert Santella, medical director at the Avera Transplant Institute.
Growth here fits steady expansion of transplant medicine. Doctors transplanted the first kidneys in the 1950s and the first heart in 1967. Rare procedures then are common now. Since 1988, doctors have done 547,050 organ transplants, including 324,551 kidneys, according to LifeSource, a Twin Cities agency that assists transplants in Minnesota and the Dakotas.
A kidney transplant can run north of $100,000 plus $20,000 a year for life in drugs and follow-up care, Santella said. But with dialysis and related costs running $75,000 a year, “by year two, it’s cheaper,” he said. Drugs do suppress a recipient’s immune system, increasing risk of cancer or infection. “But compared to dialysis, a transplant doubles or triples their life expectancy and makes them feel much better,” he said.
Sanford Health has transplanted 62 kidneys in Sioux Falls since opening its own unit in 2007. “We used to refer patients to the Avera program,” said Dr. Larry Burris, transplant nephrologist at Sanford. Waiting for an organ match can take years.
“That’s one of the reasons Avera is far beyond us. They started earlier,” Burris said. He said the two hospitals benefit by having each other in town, and they make good use of nearby transplant programs by sending lung patients to Omaha, heart patients to Minneapolis or Mayo Clinic and liver patients to Milwaukee.
Even with increasing options, the math is grim.
“Unfortunately, every day about 18 people die waiting for a transplant,” said Rebecca Ousley, spokeswoman for LifeSource in St. Paul. In Minnesota and the Dakotas, 3,283 people are waiting for organs, including 2,421 needing kidneys. Avera’s milestone needs to be seen in light of that, she said.
“It’s incredible, because every transplant that takes place is a life saved,” Ousley said. “That’s almost 1,000 lives they’ve saved.”
The Crandalls, who now live in southern Wisconsin, drove to Sioux Falls to meet recently with Ekrem and his wife, Tami, in a conference room at Avera McKennan.
In the room with them was Dr. Tariq Khan, their surgeon the next morning. Khan, 39, grew up in Hong Kong aspiring to play soccer. Instead, he went to medical school in Pakistan and, after stops in West Virginia and Dallas, ended up at McKennan in 2008. He estimates he’s done a couple hundred kidney transplants.
“It’s pretty routine surgery,” he said.
It’s also a matter of awe. The body has many bilateral pairs, including two kidneys in the abdominal cavity. Their job is to purify blood. A renal artery brings blood in, where the kidney separates the blood from water and waste products of metabolism. The kidney sends the clean blood out through a vein to return it to the body’s circulation. It sends the waste out as urine through a second opening into the ureter on its way to the bladder.
Two kidneys divide the workload 50-50, but one also can be sufficient. In body math, the second kidney is a spare part.
“You have to ask God,” Khan said. “Only God understands why you have a symmetry, two nostrils, two ears, two arms. It’s the way he liked it. I don’t have an answer for you.”
Ekrem grew up on a farm near Selby in north-central South Dakota. He had chicken pox at age 18, which a doctor said might have led to type 1 diabetes appearing at 21. What’s followed for him has been three decades of insulin injections, with syringe and needle, then a pump.
The Ekrems didn’t know until after the Crandalls moved to Wisconsin how Mary could help Ben.
Last year they would begin to find out. Ekrem for years had suspected he would need a new kidney, so he emailed friends, mentioning his wish and asking about O-positive blood.
“He didn’t know I had O-positive,” Crandall said. She discussed it with her husband. “I said, ‘I’m OK with this. Let’s call them.’ “
Crandall came to Avera McKennan, where tests confirmed a blood match and showed that Ekrem’s blood had no antibodies against her kidney. The transplant would work.
By mid-year, with Ekrem on dialysis three times a week since March, he wanted to proceed.
“He called this June,” Crandall said. “He said, ‘Are you still willing?’ I said, ‘Of course.’ “
Wednesday morning, Khan and his colleagues attended first to Crandall. At 8:30 a.m., they had made their incision and were taking delicate steps to detach her kidney.
By 9:15 a.m., the kidney was free, a slab of red flesh in the cup of Dr. Chris Auvenshine’s hand. It soon was soaking in a solution and receiving an ice bath to bring it down to 39 degrees. Auvenshine used a small tool to drip a preservative onto the kidney to supply nutrients it normally would draw from blood.
“Everything is going perfectly,” he said.
With one removed, Crandall’s other kidney began flying solo.
“The body picks up the slack almost immediately,” Auvenshine said.
At 10:05 a.m., her kidney was on its way to Ekrem’s room next door.
There, doctors reversed the process. At 12:25 p.m. Crandall’s kidney was pulsating inside Ekrem, receiving blood from his heart. Surgeons made the three critical attachments — artery, vein and ureter — and proceeded with their trimming and stitching to secure the organ in place.
By 1:30 p.m., with a rock tune on an overhead speaker, they almost were done.
“It’s the greatest gift you could give,” Ekrem told Crandall the day before. Now he was on his way to intensive care for rest. Crandall was in another room, also resting. Late last week, both were well.
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Information from: Argus Leader, http://www.argusleader.com