Local Family Awaiting Decision On Kidney Transplant

By John Voket

“…to have and to hold…in sickness and in health…”

Those words, common in conventional marriage ceremonies, have taken on a very special meaning in one particular Newtown home. After several years and several very frustrating setbacks, Phyllis Cortese is waiting anxiously for a final decision on whether she will be allowed to make one of the ultimate sacrifices to help keep her husband alive and healthy.

Sometime in the next few days, Ms Cortese will learn whether she will qualify to donate one of her kidneys to her husband John. The couple is in the final stages of testing at the Yale New Haven Hospital Transplant Center in the hope that one spouse will be able to give the gift of life and better health to the other.

This development is just the most recent chapter in a decades-long saga that has seen the local family facing both great inspiration and bitter disappointment.

Several months ago, the couple was flying high, hours away from seeing John Cortese and his younger brother, William, enter the operating room at the regional transplant center, so one brother could receive one of the kidneys from another — as close to a perfect match and ideal transplant donor-recipient scenario as doctors could hope for.

But, according to the couple, in the final hours before the scheduled procedure, doctors had to make the heart-wrenching decision to disqualify William. Final presurgical tests turned up a couple of important concerns doctors determined might eventually and negatively impact the donor’s health in the years following the procedure.

The next step was finding a new donor. And it seemed like fate was on the Cortese family’s side after some preliminary testing determined a transplant from Phyllis was a distinct possibility.

To those participating in this kind of life-giving activity, the decision to undergo a living donor transplant today is regarded as an almost routine procedure. But, according to the National Kidney Foundation, it was only a little over 50 years ago, on December 23, 1954, that Dr Joseph E. Murray transplanted a kidney from Ronald Herrick into identical twin brother Richard, the victim of fatal kidney disease.

Views regarding transplantation prior to this breakthrough were anything but enthusiastic. “We were told it was impossible and that we were playing God and shouldn’t do it,” said 85-year-old Nobel Prize winning Dr Murray in a 2004 interview.

Dr Murray’s accomplishment spawned a medical technology that would eventually save almost a half-million lives. His first kidney surgery was followed by the first liver transplant in 1963, the first heart transplant in 1968, and two decades later, the first lung transplant. Today transplantation is the routine therapy for organ failure.

Cause And Effect

For John Cortese, it all started in his late teens when he was diagnosed with diabetes.

“Admittedly, I was a typical California teenager back then,” John recalled during an interview from his Newtown farm recently. “I didn’t take very good care of myself.”

Then one fateful day almost a quarter century later, John was admitted to a West Coast hospital with extreme dehydration from what he thought was a fairly normal bout of food poisoning. But doctors said it may have been that short period of dehydration that caused his kidneys to begin shutting down.

“I remember the doctor coming in and telling me I should expect to be on dialysis for five to seven years until I could get a kidney transplant,” he said. “I think if I wasn’t a diabetic for 23 years, I may have been able to rebound. And while my kidneys didn’t shut down fully, they came pretty close.”

The trauma has left the eldest Cortese brother, one of six siblings, with about 22 percent of his original kidney function. This level of kidney activity in most patients would almost certainly warrant multiple weekly dialysis treatments where the blood is mechanically cleansed to replace the kidney’s job. But thanks to a very strict and regimented diet and exercise program, John has been able to maintain his health, and his all-important creatinine level.

While this phenomenon significantly extended the time necessary to secure a replacement kidney, the prospect of ongoing dialysis did not sit well with John or his doctors, so two years ago he decided to begin the process of ruling out possible donors. And when he heard the request for a living donor coming from his big brother, it seemed like a natural thing for Bill Cortese to step up.

But as the family learned, even when there is a blood relative offering the greatest potential for a successful transplant, there is a required procedure to ensure the donor is healthy enough to provide the contribution, according to Danbury Hospital’s Director of Renal Dialysis, Dr Winston Shih.

“Even if you have a willing family member or other potential donor, that person has to be in extremely good health or the transplant will not be allowed,” said Dr Shih. According to the doctor, who also serves as the associate program director for Danbury Hospital’s internal medicine residency program, and who is an assistant clinical professor of medicine at Yale University School of Medicine, final approval for such a procedure is taken out of the hands of the recipient and his personal physician.

“Of course I’m looking out for the best health of my patient, so I would be naturally inclined to endorse a transplant, especially when the donor is such a likely candidate like in Mr Cortese’s case — from the same gene pool,” Dr Shih said. “But maybe the health of the donor will compromise the ultimate outcome of the transplant, so these decisions are left to professionals at one of the regional transplant centers at Yale, Hartford Hospital, or down in White Plains [N.Y.].”

Dozens Of Successes

In his 16 years at Danbury Hospital, Dr Shih has attended to well over 50 patients who have undergone transplants from both living and cadaver donors. In this time he has seen amazing advances in qualifying procedures, transplant technology, and collateral pharmaceutical developments to protect the recipients and their new organs.

“It used to be that acute rejections were more widespread,” Dr Shih said. “But medical and pharmaceutical advances have had a tremendous impact on preventing or substantially reducing the severity of rejection-related issues.”

Dr Shih said, in fact, that he has heard of numerous cases where acute rejection, and even a case or two where chronic rejection, has been reversed through appropriate drug treatments.

“With a chronic rejection it’s hard to reverse. Most do not, but in even acute rejection situations, if patients strictly adhere to the pharmaceutical protocol, it greatly reduces the threat of outright rejection,” Dr Shih said.

The doctor said that in cases where the procedure and follow-up care are handled properly, the patient can expect to live a long and relatively normal postoperative lifestyle. He said today, society is much more aware of the successes and advances related to kidney and other organ transplants. And because of this, he is a strong advocate for organ donation initiatives.

“Most people should consider becoming a donor,” he said. “Most people in relatively good health can provide numerous opportunities to save lives and greatly enhance the quality of lives through individual organ donations at the time of death.”

Dr Shih said although many living kidney donors know the potential recipients, he has seen three or four occasions in the past few years right in the Danbury region where total strangers have read or heard about the need for a kidney donation and stepped up without hesitation once they became qualified to donate.

“This is the most wonderful experience for me, and others in our profession,” Dr Shih said.

The sentiment is no less impressive for John Cortese. And as he and wife wait for the final determination regarding her selfless offer to donate a kidney, the pair is already looking past the procedure for opportunities to reach out and help educate the public about this tremendous gift of life virtually everyone has to offer.

“After all, we are a society that recycles everything from mechanical equipment to soda cans, so why not gain a greater appreciation and acceptance of organ recycling through donation,” John said.

“And if we can impress anyone about the importance of organ donation, we hope someone reading this will go out and check that organ donor box on their driver’s license, and go through the simple witnessing procedure to ensure their donor card can speak for them in the unfortunate event of a tragedy,” Phyllis added.

The Coteses say the next best thing an individual facing the prospect of a kidney transplant can do is become as well-educated as possible about every aspect of the procedure.

With that in mind, the National Kidney Foundation of Connecticut is sponsoring a free, information seminar entitled, “Getting Answers: Preparing for an Organ Transplant” next Tuesday, September 27, at Danbury Hospital, beginning at 5:30 pm.

Open to the general public, the two-and-a-half-hour seminar includes a light dinner. Kidney foundation and medical representatives are hoping to further educate and inform people about organ transplantation, and will discuss topics including pretransplant evaluation and testing, psychosocial issues, financial matters, nutrition, and postoperative expectations. Several transplant professionals from Yale New Haven Transplant will present information about organ transplantation and will answer questions.

According to a preevent release, there are currently more than 500 Connecticut residents just like John Cortese, who are anxiously awaiting transplants. For more information or to register for the seminar, contact Donna Sciacca at the NKF of CT at 800-441-1280, extension 10.