In May 2019, Kim traveled to New York City for two more days of rigorous testing, including a CT scan, X-rays, and a stress test. Duncan went through his own series of tests, both siblings now under the care of the team at NewYork-Presbyterian/Columbia. Kim met Dr. Ratner, her surgeon, as well as a social worker, a coordinator, and a psychiatrist. “We want to make sure potential donors aren’t being coerced and that they understand what they are getting into,” says Dr. Ratner.
Kim sailed through, though being at the hospital was a bit surreal. “I felt like, ‘Oh my God, this is really happening,’” she says. Adding to that sense of disbelief was the fact that Kim had no idea what the doctors might find. “When you’re adopted and have no family history, you’re in the dark,” she says. “I just crossed my fingers and prayed there would be a good result.”
Duncan was also on tenterhooks, hoping that, if all went well with Kim, a transplant could happen by mid-summer. “It was tough waiting because dialysis was a grind,” he says. But once he and his wife met with his surgeon, Dr. McCune, his anxiety eased. “We were thrilled,” he says. “Dr. McCune was calm, a straight shooter, and clearly a rock star in the department.”
Dr. McCune was equally optimistic. “Many of our transplant patients also have diabetes or high blood pressure, but Duncan’s blood vessels were nice and healthy. That makes the surgery a joy to do, because we know we are going to get a good outcome.”
On August 13, 2019, both Kim and Duncan were wheeled into adjacent operating rooms on the third floor of NewYork-Presbyterian/Columbia University Irving Medical Center. What lay ahead: five or six hours of surgery, with the donor going first. In Kim’s case, the plan was for Dr. Ratner to remove her kidney with a minimally invasive technique known as laparoscopic nephrectomy, which he and a colleague were the first in the world to perform in 1995. “Compared with open surgery, patients recover faster,” he says.
Once Kim’s kidney was excised, the blood was flushed out, to prevent clotting, then the kidney was packed in slushy ice bags, covered with a sterile sheet, and wheeled across the hall, where Duncan was waiting.
Dr. McCune then picked up the baton, placing the new kidney—“about the size of a pocketbook,” she says—in Duncan’s abdomen. “The abdomen is more accessible to the bladder, which makes things easier,” she explains. Duncan’s own two kidneys were left in place. They would eventually stop working completely, then “shrivel up to the size of walnuts,” she says.
What happened next seems almost miraculous, even to seasoned surgeons like Drs. McCune and Ratner: “The new kidney started working immediately,” says Dr. McCune. Indeed, by the end of that first night, Duncan’s kidney had put out 6 to 10 liters of urine, removing the toxins that had built up in his body. “Most people urinate about 1½ liters a day,” says Dr. McCune. “But when we put a healthy kidney into someone with renal failure, it goes crazy.”
Duncan wasn’t initially aware of what was happening. Instead, his concern was for his sister. “I’m told that the first thing I asked when I woke up was, ‘How’s Kim doing?’” he recalls. Kim was feeling well enough to take a walk down the hall to Duncan’s room the day after surgery, trailed by her IV pole and Aiyana and Makani. “I wanted my kids to be a part of the experience,” says Kim. “I want them to be able to share the fact that I donated a kidney—and let people know that it’s good to donate if you can.”
Indeed, Kim was out of the hospital after two nights, and back to work within a month. Duncan’s recovery was equally swift. “I had every confidence in Dr. McCune, which was borne out on the day of surgery,” says Duncan. “It couldn’t have gone better. I’m just really grateful to Dr. McCune and the whole team.” He was out of the hospital in four days, his creatinine down to 1.2, a healthy level. And while rejection of the kidney occurs in 10% to 15% of cases, “it’s reversible with medication 99% of the time,” says Dr. McCune. After a year, the chances of rejection drop dramatically, though Duncan will continue to return for regular checkups with his transplant nephrologist Dr. Chang and will take immunosuppressant drugs for the rest of his life. But a mere four weeks after the transplant, he was also back at home, getting back to work, and enjoying time with his family.