Carol Smith of Fargo is getting an early Christmas gift from her daughter, Erica Jodsaas - a kidney.

Fittingly enough, a radio in the MeritCare operating room is tuned to a country music station that's playing "The Christmas Song" at 11:40 a.m. as Dr. Bhargav Mistry hooks up Jodsaas' kidney to Smith's body.

Face-up on the table, Smith is covered with blue surgical draping. The only visible part of her is a small area, perhaps a square foot, around the incision; her skin is stained bright orange with iodine disinfectant and, because the surgeon cauterizes as he cuts, there isn't much blood.

The kidney that was her daughter's rests on the edge of Smith's incision, sandwiched between two ice packs to ensure it doesn't deteriorate before the blood supply is connected.

Before it goes in, Mistry has to clear a space in Smith's groin, where the organ will reside.

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Her old kidneys, rendered useless by lupus, won't be removed. They will remain hooked up to her circulatory system so they won't die, but eventually the donated kidney will take over the role of cleansing her blood.

Mistry works quietly and efficiently. A transplant kidney remains viable for up to 48 hours after it's taken from the donor, but the quicker it can go in, the better. Jodsaas' kidney was removed less than two hours ago.

There isn't much idle chatter among the doctors and nurses. There is none of the drama of TV-show operating rooms. For the doctors and nurses who work on Smith, it is just another day at the office.

Smith's is the 201st transplant at MeritCare since Mistry arrived four years ago. The 200-transplant milestone was reached with a Nov. 17 kidney operation.

In the 10 years before Mistry's arrival, a partnership among MeritCare, Dakota Heartland Hospital and Dakota Clinic had performed 184 transplants. That partnership ended in 1998, when Dakota Heartland pulled out.

A downhill slide

Speaking the day before the transplant, Smith, 52, says she was diagnosed with lupus 30 years ago - four years before her daughter was born. An autoimmune disease that causes the immune system to attack the body itself, the disease has made Smith steadily sicker over the years.

"I've been going downhill for the last 10 years," she says.

It primarily affected her kidneys and lungs. In recent months, she was retaining fluid - "I didn't even have ankles any more," she says - and was constantly tired. She was cold all the time, even in July.

With her kidneys failing rapidly, she agreed to a transplant in September. The plan gained urgency early in November, when she had to go on dialysis.

Her husband, Doug, 56, was tested as a donor, but found unsuitable. That's when Jodsaas stepped in, over her mother's initial objections.

"Right when I found out my Mom needed a kidney, I was like, 'Well, I'll give her mine,'" Jodsaas says. "There was never a question in my mind."

Jodsaas told her mother that there would be no long-term health effects on her as a donor and kept after Smith to approve her. Finally, Smith says, "She just wore me down."

"She was feeling so bad, she just didn't have much choice," Doug Smith says.

Still, even on the eve of the surgery Smith was not completely enthused about taking her daughter's kidney. "It's hard to think she's going to be in pain because of me," she says.

Jodsaas was free of any doubt. "I would give my mom anything," she says. "She has always been there for me. She's a wonderful, wonderful mother. She deserves it. She needs it."

The transplant took place Tuesday.

Jodsaas went into surgery just before 8 a.m. and was in recovery by the time Smith's operation, which lasted about three hours, began at 11 a.m.

Mistry says there were no complications.

He should know. He came to MeritCare in September 2000 specifically to do transplants. He was trained in India, the United Kingdom and St. Louis, his last home before moving to Fargo.

Smith's operation was his 167th kidney transplant since he arrived. He also has done 34 pancreas transplants. He is trained to do liver transplants as well, but demand for those is so low here that patients needing them are sent either to the Mayo Clinic in Rochester, Minn., or to Minneapolis.

MeritCare Transplant Coordinator Brian McKeever says 98 percent of the hospital's kidney transplant patients are still alive a year after the surgery. That figure, which is comparable to national statistics, does not include those who die from causes unrelated to the surgery, McKeever says.

Transplants evolve

The first successful kidney transplant was performed on twin brothers 50 years ago this year in Boston.

The surgery remained in its infancy through the late 1950s and early 1960s, Mistry says. Because tissue matching was not as well understood as it is today, and because some anti-rejection drugs didn't even exist, outcomes were poor. More than half of transplanted kidneys were rejected within six months of the operation. Today, more than 90 percent of transplanted kidneys still are functioning a year later.

Changing donation procedures also helped the operation's success. Before 1968, a kidney could not be taken until a donor's heart had stopped. By the time it was removed, it would have gone a half-hour or longer without any blood flow, often damaging the organ. But in the late 1960s, states began allowing organ donations after brain death; brain-dead donors' bodies could be kept functioning artificially until the organs could be taken.

A landmark in transplant surgery came in 1983 with the creation of cyclosporin, an anti-rejection drug. It dropped the rejection rate on transplanted organs from more than 50 percent to less than 20 percent.

At the same time, doctors learned how to prepare the recipient's body for a donor organ.

"When we do a transplant on somebody, it's a fine balance," Mistry says. The anti-rejection drugs make the body less able to fight off infection, making the surgery a potential medical Catch-22: a new, better-working organ in a weaker body.

Doctors now give patients antibiotics ahead of time to build resistance to infection and make sure recipients are completely up-to-date on their immunizations. After the transplant, recipients stay on antibiotics for three to six months.

Surgical techniques also have changed. Until 1995, kidneys were taken from donors through the back, making recovery longer (up to six weeks) and more painful. Now, the kidney, which is about the size of a fist, is removed laproscopically. Working through a small incision, the doctor severs the vein, artery and ureter and removes the organ without making a major incision. Donors who once would have spent a week recovering in the hospital now leave within three days and can be back to work in two weeks.

Because kidney transplants are relatively simple compared to those of any other organ, it is the most common transplant surgery in the world. More than 10,600 have been performed this year in the United States, according to the United Network for Organ Sharing, a clearing house for organs needed by transplant centers.

But as with other organ transplants, demand has not kept up with supply.

"The transplant has become a victim of its own success," Mistry says.

At one time, kidney recipients could be no older than 55, but as the operation has become more routine that age limit has disappeared. Mistry says he once transplanted a kidney into a 77-year-old.

Nationwide, almost 87,000 people are awaiting a donor organ, according the Organ Sharing network. More than 60,000 of those need kidneys and more than 1,600 need a pancreas.

Only about 8,000 kidneys a year become available from deceased donors, Mistry says, meaning the rest must come from a "more or less static" donor pool.

Late in the week, with both donor and recipient still recovering, Smith's transplant appears to have worked.

Speaking Friday, hours after she was released from the hospital, Jodsaas says Mistry told the family the kidney started working soon after the transplant. Smith had to have more surgery Friday due to internal bleeding around the kidney caused by blood thinners, but that's not unusual, Jodsaas says.

The donor says she's tired and sore, but expected to feel that way. Still, Jodsaas says, "you don't really know what it's going to feel like until you're actually there."

Readers can reach Forum reporter

Tom Pantera at (701) 241-5541By Tom Pantera

tpantera@forumcomm.com

Carol Smith of Fargo is getting an early Christmas gift from her daughter, Erica Jodsaas - a kidney.

Fittingly enough, a radio in the MeritCare operating room is tuned to a country music station that's playing "The Christmas Song" at 11:40 a.m. as Dr. Bhargav Mistry hooks up Jodsaas' kidney to Smith's body.

Face-up on the table, Smith is covered with blue surgical draping. The only visible part of her is a small area, perhaps a square foot, around the incision; her skin is stained bright orange with iodine disinfectant and, because the surgeon cauterizes as he cuts, there isn't much blood.

The kidney that was her daughter's rests on the edge of Smith's incision, sandwiched between two ice packs to ensure it doesn't deteriorate before the blood supply is connected.

Before it goes in, Mistry has to clear a space in Smith's groin, where the organ will reside.

Her old kidneys, rendered useless by lupus, won't be removed. They will remain hooked up to her circulatory system so they won't die, but eventually the donated kidney will take over the role of cleansing her blood.

Mistry works quietly and efficiently. A transplant kidney remains viable for up to 48 hours after it's taken from the donor, but the quicker it can go in, the better. Jodsaas' kidney was removed less than two hours ago.

There isn't much idle chatter among the doctors and nurses. There is none of the drama of TV-show operating rooms. For the doctors and nurses who work on Smith, it is just another day at the office.

Smith's is the 201st transplant at MeritCare since Mistry arrived four years ago. The 200-transplant milestone was reached with a Nov. 17 kidney operation.

In the 10 years before Mistry's arrival, a partnership among MeritCare, Dakota Heartland Hospital and Dakota Clinic had performed 184 transplants. That partnership ended in 1998, when Dakota Heartland pulled out.

A downhill slide

Speaking the day before the transplant, Smith, 52, says she was diagnosed with lupus 30 years ago - four years before her daughter was born. An autoimmune disease that causes the immune system to attack the body itself, the disease has made Smith steadily sicker over the years.

"I've been going downhill for the last 10 years," she says.

It primarily affected her kidneys and lungs. In recent months, she was retaining fluid - "I didn't even have ankles any more," she says - and was constantly tired. She was cold all the time, even in July.

With her kidneys failing rapidly, she agreed to a transplant in September. The plan gained urgency early in November, when she had to go on dialysis.

Her husband, Doug, 56, was tested as a donor, but found unsuitable. That's when Jodsaas stepped in, over her mother's initial objections.

"Right when I found out my Mom needed a kidney, I was like, 'Well, I'll give her mine,'" Jodsaas says. "There was never a question in my mind."

Jodsaas told her mother that there would be no long-term health effects on her as a donor and kept after Smith to approve her. Finally, Smith says, "She just wore me down."

"She was feeling so bad, she just didn't have much choice," Doug Smith says.

Still, even on the eve of the surgery Smith was not completely enthused about taking her daughter's kidney. "It's hard to think she's going to be in pain because of me," she says.

Jodsaas was free of any doubt. "I would give my mom anything," she says. "She has always been there for me. She's a wonderful, wonderful mother. She deserves it. She needs it."

The transplant took place Tuesday.

Jodsaas went into surgery just before 8 a.m. and was in recovery by the time Smith's operation, which lasted about three hours, began at 11 a.m.

Mistry says there were no complications.

He should know. He came to MeritCare in September 2000 specifically to do transplants. He was trained in India, the United Kingdom and St. Louis, his last home before moving to Fargo.

Smith's operation was his 167th kidney transplant since he arrived. He also has done 34 pancreas transplants. He is trained to do liver transplants as well, but demand for those is so low here that patients needing them are sent either to the Mayo Clinic in Rochester, Minn., or to Minneapolis.

MeritCare Transplant Coordinator Brian McKeever says 98 percent of the hospital's kidney transplant patients are still alive a year after the surgery. That figure, which is comparable to national statistics, does not include those who die from causes unrelated to the surgery, McKeever says.

Transplants evolve

The first successful kidney transplant was performed on twin brothers 50 years ago this year in Boston.

The surgery remained in its infancy through the late 1950s and early 1960s, Mistry says. Because tissue matching was not as well understood as it is today, and because some anti-rejection drugs didn't even exist, outcomes were poor. More than half of transplanted kidneys were rejected within six months of the operation. Today, more than 90 percent of transplanted kidneys still are functioning a year later.

Changing donation procedures also helped the operation's success. Before 1968, a kidney could not be taken until a donor's heart had stopped. By the time it was removed, it would have gone a half-hour or longer without any blood flow, often damaging the organ. But in the late 1960s, states began allowing organ donations after brain death; brain-dead donors' bodies could be kept functioning artificially until the organs could be taken.

A landmark in transplant surgery came in 1983 with the creation of cyclosporin, an anti-rejection drug. It dropped the rejection rate on transplanted organs from more than 50 percent to less than 20 percent.

At the same time, doctors learned how to prepare the recipient's body for a donor organ.

"When we do a transplant on somebody, it's a fine balance," Mistry says. The anti-rejection drugs make the body less able to fight off infection, making the surgery a potential medical Catch-22: a new, better-working organ in a weaker body.

Doctors now give patients antibiotics ahead of time to build resistance to infection and make sure recipients are completely up-to-date on their immunizations. After the transplant, recipients stay on antibiotics for three to six months.

Surgical techniques also have changed. Until 1995, kidneys were taken from donors through the back, making recovery longer (up to six weeks) and more painful. Now, the kidney, which is about the size of a fist, is removed laproscopically. Working through a small incision, the doctor severs the vein, artery and ureter and removes the organ without making a major incision. Donors who once would have spent a week recovering in the hospital now leave within three days and can be back to work in two weeks.

Because kidney transplants are relatively simple compared to those of any other organ, it is the most common transplant surgery in the world. More than 10,600 have been performed this year in the United States, according to the United Network for Organ Sharing, a clearing house for organs needed by transplant centers.

But as with other organ transplants, demand has not kept up with supply.

"The transplant has become a victim of its own success," Mistry says.

At one time, kidney recipients could be no older than 55, but as the operation has become more routine that age limit has disappeared. Mistry says he once transplanted a kidney into a 77-year-old.

Nationwide, almost 87,000 people are awaiting a donor organ, according the Organ Sharing network. More than 60,000 of those need kidneys and more than 1,600 need a pancreas.

Only about 8,000 kidneys a year become available from deceased donors, Mistry says, meaning the rest must come from a "more or less static" donor pool.

Late in the week, with both donor and recipient still recovering, Smith's transplant appears to have worked.

Speaking Friday, hours after she was released from the hospital, Jodsaas says Mistry told the family the kidney started working soon after the transplant. Smith had to have more surgery Friday due to internal bleeding around the kidney caused by blood thinners, but that's not unusual, Jodsaas says.

The donor says she's tired and sore, but expected to feel that way. Still, Jodsaas says, "you don't really know what it's going to feel like until you're actually there."

Readers can reach Forum reporter

Tom Pantera at (701) 241-5541