NORFOLK, Va. (AP) - Lesley Jenkins sat at her kitchen table in the glow of her computer screen.
It was about midnight when she logged on to talk to a Sentara Healthcare medical team, which included a nutritionist, social worker and surgeon. They spoke for an hour about the risks of surgery and how to take care of her health for the long haul. There were medical history and consent forms to sort out.
Before the Zoom session ended, she gave them a tour, showing them a bit of the Hibiscus Coast. The New Zealand view was spectacular for the team, not just because of where Jenkins was in the world but what it represented.
Despite the 8,600 miles between Jenkins and her brother, Steve Morrison, they were planning for her journey to him in July to donate her left kidney. No donor has ever traveled that far for a transplant surgery in Norfolk.
The distance pushed Sentara to use telehealth technology in its preliminary intake process, a first for the hospital system. The medical team says this could open the doors for easier long-distance organ matches in the future. Now any out-of-town, living donors can do evaluations remotely, potentially saving prohibitive travel costs.
The challenge alone - a surgery with a donor who comes from a different health care system on the other side of the world - made Morrison’s transplant extraordinary. But in the age of the coronavirus, an infectious disease that has swept the globe, the siblings overcame countless other obstacles: lockdowns, travel restrictions, a surgery delay of 3 ½ months, multiple quarantines and nail-biting days waiting for COVID-19 test results to come back all-clear.
“I feel like I’ve been on this roller coaster for a few months,” Jenkins said.
The coronavirus has had an unprecedented impact on organ transplants. Leading up to the pandemic, about 370 deceased-donor kidneys were recovered in the United States weekly. At the end of March, after the disease had sufficiently made landfall, there were about 200, according to the United Network for Organ Sharing, a private nonprofit that manages the U.S. organ transplant system.
But the effect was even more dramatic on transplants involving living donors. Prior to COVID-19, surgeons were conducting about 140 a week nationwide. That dropped to about 10, with essentially all transplant programs grinding to a halt in early April.
While hospitals reckoned with how to safely resume the surgeries, many would-be recipients were “inactivated” on organ waitlists, meaning program leaders believed their risk of getting the illness during and after surgery outweighed the urgency of their procedure.
Margaret Sullivan, Sentara’s director of transplant services, said Norfolk General Hospital delayed about a half-dozen living donor transplants this spring while they worked on new protocols. That decision came around the same time Gov. Ralph Northam issued an executive order postponing non-urgent medical procedures to free up bed space and resources. The ban, however, wasn’t a factor because transplants weren’t restricted.
“We pushed back living donors to keep them safe,” she said. “They’re well people. You don’t want to bring them in and make them sick.”
For Morrison, chair of the School of Rehabilitation Sciences at Old Dominion University, that meant his surgery, scheduled for April 28, was delayed. His classes had been put on hold, too, because of the virus, but he couldn’t imagine that lasting for more than a couple of weeks.
As the outlook worsened for the pandemic, he started to get more nervous and felt time running out. His kidney function was at about 12% in July, he recalls. He knew that when it got down to 8%, nephrologists tend to refer patients to dialysis.
“I had about three or four months left, if I declined at the same rate,” he said. “That was a big concern. I really didn’t want to go on dialysis, but I was just so exhausted.”
GETTING THE DIAGNOSIS
Morrison, 56, didn’t know he had a health problem until he was playing soccer one day and accidentally got a whack on the back from another player.
That night, about a decade ago, he passed a kidney stone and went to the hospital. That’s when doctors discovered he had polycystic kidney disease.
About two years ago, he was verging on kidney failure, and doctors recommended he get on a transplant waitlist. His wife, sister-in-law and friends had been considered as donors. None was a match.
Morrison didn’t know how he was going to tell his then 86-year-old mother. But when he asked Jenkins for advice, she offered something better.
“What if I gave you a kidney?” she asked, believing their blood types were both A-positive.
In December, Jenkins, 61, got her work-up to determine if she was a candidate and enroll her in the transplant program. She saw a nephrologist and had tests conducted in her home country, which has a socialized health care system. Normally, exams and labs would be free, but she opted to pay the equivalent of about $1,350 for certain services to ensure they happened quickly.
Roland French, a transplant coordinator who facilitated Morrison’s case from Norfolk, said costs and travel visas are some of the foremost issues that stymie family members abroad from donating. In addition to medical expenses, they’ve had to pay for travel back and forth for their preliminary screenings. Then came travel costs for the surgery.
This year, as the virus hopped from one continent to another, some countries quickly threw up travel restrictions. At one point, all flights were canceled out of New Zealand, a small island nation of about 5 million people that aggressively instituted infectious disease controls. Since the onset, New Zealand has recorded less than 1,400 cases of COVID-19 and 22 deaths.
The anxiety of not being able to get to Virginia was amplified when the transplant program tabled his surgery: When, then?
Dr. Tom McCune, a Sentara nephrologist, said Morrison should have gotten a transplant immediately, but they feared his sister would be at risk of exposure traveling through airports and on airplanes. Organ recipients also are at higher risk of dying of a coronavirus infection because of the immune system-suppressing drugs they take to prevent rejection of the donor organ. At the time, U.S. public health officials were struggling to even nail down accurate testing methods and getting results quickly enough to have an impact.
Meanwhile, Morrison and his wife, Denise, both health professionals, said they did all they could to avoid getting sick. They wore masks in public and only visited with friends outdoors. They wiped down groceries, washed their hands frequently and hoped that hand sanitizer could help fend off the bug.
When the surgery was rescheduled for Aug. 11, the tables had turned. Jenkins was now the one eyeing how Virginia was handling cases. Hampton Roads was having a surge, with Northam restricting businesses more to try to curb the disease. While nasal swab tests were coming back positive about 6% of the time throughout the state, the Tidewater region was seeing higher rates of 9% to 18%.
But as long as flights were taking off, Jenkins resolved to be on one.
When she arrived in San Francisco on July 26, she almost was denied entry. Born in Scotland, Jenkins travels on a British passport, which raised eyebrows at Customs. When she explained she was donating a kidney to her brother, she said she was asked if she could show his passport.
Huh?
After some back-and-forth and looking up her brother on the internet, she was cleared.
“I told them, ‘I am the package,’” she said.
But perhaps the most nerve-wracking stop was in Atlanta, a busy international hub where people were nearly bumping and colliding as they rushed to their terminals. Not a lot of people were wearing masks, she said.
When she reached Norfolk, she had one more in-person exam. Doctors reviewed a CT scan of the arteries and veins connected to her kidneys. Poor findings could have stopped the procedure from going forward.
Both Jenkins and Morrison underwent COVID-19 tests about 72 hours before the operation. A positive result could have also been a roadblock.
Fortunately, they made it to Surgery Day, unscathed by the virus, but weary of the ride it had taken them on.
When the surgery was done, Jenkins was down a kidney, and Morrison was up to three. His two were left in place, sputtering along.
Three days later, Jenkins and Morrison were discharged.
RECOVERING AND RECONNECTING
Today, living-donor organ transplants are returning to pre-pandemic levels. That has been the case at Norfolk General, which is one of seven transplant centers in Virginia.
After the public health crisis is in the rear-view mirror, some of the new transplant protocols may be here to stay, McCune said. Doctors will likely be more upfront about explaining to donors and recipients the steps they should take to avoid getting infections before surgery, and short-term quarantines might become routine.
Jenkins touched down in the states just in the nick of time. As she began her two-week, pre-op quarantine at Morrison’s house, New Zealand locked down again. Officials have been trying to stop a small resurgence in Auckland, the country’s largest city.
For the siblings living on different hemispheres, separated by the Pacific Ocean and the breadth of the United States, recovery turned out to be a rare chance to reconnect. They hadn’t lived together since college, when they shared a house with their older brother. Morrison is a better roommate than in those days, Jenkins said. Even on the brink of kidney failure, he does more dishes.
For a few weeks, they binged on “Seinfeld” and “Umbrella Academy” and took short daily walks around the block with Morrison’s two little dogs. He watched his sister crush five 1,000-piece puzzles, all in the span of their post-op quarantine.
They also bonded over a peculiar side effect on their taste buds. Jenkins noticed tea has become super sweet since surgery, and Morrison had found even bland foods to be flavorful.
“Green beans, the most innocuous thing, just explode in my mouth,” he said.
After a follow-up exam and another nasal swab test, Jenkins returned to New Zealand last week. There she’s undergoing yet another 14-day quarantine in an isolation hotel paid for by her government.
Though she wishes she could heal at home, she’ll have her work computer with her to stay busy. She also plans to keep in close touch with her four children and nine grandchildren.
As for Morrison, he’s now the caretaker of the family kidney, which at the moment requires about 12 medications to help it function.
But having a pandemic transplant has been worth every bump in the road, he says. He feels fortunate to have had a Kiwi sister who is also A-positive.
“Probably the easiest ’A’ I’ve ever gotten,” he said.
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