Feature: Region 1 Medical Center’s First Kidney Transplant

By Alex Romeo R. Fernandez

Hospitals offer little respite for their personnel, particularly those assigned to the emergency section and the operating room.

The last Sunday of September 2012, however, offered an even heightened urgency to doctors of Region 1 Medical Center assigned in two operating rooms.

At around 7:30 a.m., Govina Onrubia, 28, and a resident of Dagupan City, was being wheeled to Operating Room 1 for an operation to replace one of her failing kidneys.

Govina had been suffering from glomerulonephritis, or the inflammation of the kidneys.

The patient’s condition, according to Dr. Abraham Coquia, one of the members of the National Kidney and Transplant Institute (NKTI) that undertook the transplant, is caused by a compromised immune system, although the direct mechanism linking the cause to the disease is still unclear.

Her donor and cousin Isagani Patungan, 32, also of this city, had already been prepped in Operating Room 2.

Outside the sterile operating rooms, media personnel invited to cover the operation were asked to suit-up from head to foot: from head wear to face mask, to gown, to sterile pajamas down to the booties.

The covering media men were also told by one of the doctors not to touch anything in the operating room — not the surgeons, the instruments or the crate in which the instruments lay to prevent infecting the patients.

Stripped down, the donor lay on his side. His vital signs were being monitored, with electrodes connected to his body to some three or four beeping electronic instruments flashing numbers, indicating heartbeat, blood pressure, among others.

Already, his right hand propped to a contraption to prevent him from moving while the operation was ongoing.

Above him was the adjustable overhead light, shaped like an inverted flower with six hexagonal petal riddled with small red and blue lights. Protruding from the middle was the main light that served to illuminate the operation.

Now nearing the actual operation, the doctors daub antiseptic on the patient’s belly and then placed green surgical cloth over his body so that only the portion that will be cut showed.

It was 8:20 a.m. when the initial incision was made on donor. One could hear the hissing sound as the searing cauterizing knife cut through flesh, and one could also smell burning flesh as its odor permeated the air.

There was little blood. During the initial phase, one would even wonder why no blood was visible.

The cut went deeper, the smell intensified.

The doctors seemed to be doing the same thing repeatedly: ask an instrument from an assistant, probe the cut, make another cut and then ask for replacement of an instrument again.

Dr. Paquito Fuentes who led the operation moved patiently as he went deeper into the body to extract the kidney.

Another doctor wiped gauze around the cut. There was blood in it, but only superficial, not soaked.

As the operation went on, a nurse started preparing a crate where the extracted kidney will be cleaned. The nurse, using a pair of tongs, laid several pieces of green sterile cloth over the crate and over it placed a metal basin where the kidney will be soaked in a liquid and frozen mixture.

The donor’s kidney has now been tied to a string of gauze to make it easier for the doctor to move it while it is being removed.

The organ is now nearing extraction.

At the adjacent operating room, the recipient lay supine on the operating bed. Already cut, she was waiting for the doctors in the other room to finish.

Dr. Adolfo Parayno, who was to lead the other half of the transplant, moved into Operating Room 2 to check the progress of the extraction.

Dr. Fuentes made his cut. It was 10:50 a.m.

As soon as the organ was removed, Dr. Parayno immediately immersed it in the solution, removed the extraneous flesh; and in one of the vessels, inserted a tube connected to liquid-filled plastic canister.

The kidney was the shape of a bean, with length about three quarter the size of open adult palm and no more than two inches thick.

Connected to similar instruments as his donor, Onrubia was now prepared to receive the organ.

The same scene happened, only backward—stitching instead of cutting, closing instead of opening–and without the smell of burning flesh.

Nurses now crowded behind the glass entrance of the operating rooms, watching eagerly as the doctor patiently worked on his patient.

As soon as the kidney had been infused into recipient, the doctors finally tested it. It has to draw out urine. And when it did, they knew it was functioning.

It was the highlight of the operation, the indication that the transplant was a success.
It was already past 1 p.m.

The operation was not the first kidney transplant done in the city, but it was the first one for a government-owned hospital in Region 1.

Dr. Coquia, spokesperson for NKTI in the region, said patients are already lined-up for subsequent transplants. (ANL/ARRF-PIA 1, Pangasinan)

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