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Sister to sister: The gift of a healthy kidney

June 14, 2018 | UCI Health
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Xenia Morales, left, and her older sister, Nadia.

Three days after Christmas in 2013, 23-year-old Xenia Morales experienced such severe chills that even layers of blankets couldn’t keep her warm in the Huntington Beach home where she lives with her parents.

With her pulse barely registering, her family rushed her to the closest emergency room.

‘Big crush in my heart’

“When they finally let me in, I saw her lying there with all these needles, lines, tubes everywhere,” says her sister, Nadia Morales, then 27. “The doctor says, ‘Do you know she’s dying?’ and I felt this big crush in my heart.”

Within months, Xenia sought the help of UCI Health nephrologists and later that year she had a new kidney, thanks to her sister — and donor — and the expanding UCI Health kidney transplant program.

Blood the color of pink lemonade

Until the weekend she fell ill, Xenia had been healthy and busy, taking college classes and attending beauty school, plus working to pay tuition. She’d recently passed the state test for her cosmetology license and had accepted a job at a beauty salon. But on the Sunday before she was scheduled to start her job, her kidneys quit working.

Xenia’s kidneys were unable to do their job of filtering waste and extra fluid from her blood, turning her blood the color of pink lemonade. She needed a transfusion of 10 units of blood, which is just about the total amount her body held. Doctors told her family that without emergency care she would have died within a few hours.

Underdeveloped kidneys

While there are many causes of kidney failure — from diabetes to heart disease to drug abuse — in Xenia’s case, her kidneys hadn’t developed properly after her premature birth at 8 months gestation.

Yet no one was aware that her kidneys were much smaller than the normal size of a human fist, and their failure at age 23 came as a complete surprise.

As Xenia battled her illness and began kidney dialysis, the sisters became almost inseparable. In the intensive care unit and hospital, at doctor visits and dialysis treatments, Nadia never left her sister’s side. Nadia encouraged her whenever Xenia felt like giving up.

Becoming her sister’s caretaker

Nadia also researched the advantages of peritoneal dialysis, which fills the abdomen with a special solution to clean the blood, and she convinced Xenia it would give her greater independence and quality of life. Nadia even acted as her needle-shy sister’s caretaker by cleaning and maintaining the dialysis lines.

Inseparable before the ordeal, the two sisters are even closer. They tell the story together, both contributing different pieces of it and frequently finishing each other’s sentences. Four months after Xenia’s collapse, Nadia made the decision to give one of her own kidneys to her sister — and it truly became their story.

Thousands languish on wait list

It’s one that too few kidney failure patients can claim. In 2016, more than 19,000 U.S. kidney transplants were performed. That’s a record high, but more than 100,000 people still languish on the list waiting for a replacement kidney.

The problem is a lack of kidneys from both deceased and live donors. In Orange County, the wait for a deceased donor kidney can be as long at 10 years.

“A live donor is gold,” says Dr. Donald C. Dafoe, who is UCI Health’s chief of transplant surgery. “If someone comes to us with a live donor, we can do that transplant within three to six months once all testing is complete.”

Committed to donation despite the risks

After Nadia decided to donate one of her healthy kidneys, she turned out to be almost a perfect match, lining up with Xenia on five of six biomarkers. The more biomarkers that match, the less risk there is that the recipient’s body will reject the donor kidney.

“When the transplant team nurse called to give me the good news,” Nadia says, “I knew that God had his own plan.”

The sisters went back and forth over the usual questions:

  • Are you sure you want to do this?
  • What if something happens and you need the kidney later on?
  • What about the dietary restrictions you’ll have to follow after surgery?

But Nadia was committed.

On Dec. 14, 2014 — just months after learning of the match — the sisters headed to UC Irvine Medical Center in Orange for the transplant surgery.

Successful kidney transplant odds improving

xenia and nadia morales sitting on a bench The odds of successful transplants have improved greatly in recent years, thanks to advances in drugs and aftercare, says Dafoe. These improvements also have expanded the number of candidates who qualify for transplants. Yet the need has also increased because of our aging population along with the soaring rate of type 2 diabetes, which often leads to serious kidney disease.

The UCI Health kidney transplant program is expanding to meet this mushrooming need and to ensure that area residents get top-notch care where they live.

Outcomes that beat the national average

“We’re on solid footing to become the face of transplant in Orange County,” says nephrologist Dr. Uttam G. Reddy, medical director of the kidney transplant program.

“Our outcomes are better than the national average — on par with some of the top transplant programs in the country. That’s the gold standard for me.”

In addition, UCI Health’s state-of-the-art outpatient dialysis program helps prolong the lives of people with kidney failure, including those who are waiting for a kidney donor or who aren’t candidates for transplantation. The nephrology team also supports home peritoneal dialysis and hemodialysis, and it staffs an inpatient unit for acute dialysis at the medical center.

Transplants better than dialysis

Even with the best care, dialysis isn’t as good as a transplant.

“The five-year survival rate for people on dialysis is only 50 percent,” says Dr. Hirohito Ichii, the surgeon who transplanted Nadia’s kidney into her sister in a seven-hour operation. “The prognosis and quality of life is much higher with transplant.”

“It’s also way more cost-effective in the long run,” Dafoe adds. “Comparing dialysis to transplant, transplant begins to pay off after three years. It’s a win all around.”

Although Xenia’s body didn’t reject Nadia’s kidney, the road to recovery was filled with bouts of infection because of the ways in which transplantation can compromise the immune system.

Training to help other kidney failure patients

Healthy now, Xenia is pursuing a degree in psychology and hopes to work as a therapist helping patients cope with kidney failure.

Both sisters are occasionally asked to share their experiences with people facing similar situations. Neither regrets their choices. And they couldn’t be happier with the care they received at the medical center.

“The care at UCI was amazing,” Xenia says. “The transplant team makes sure you’re really well taken care of,” says Nadia, who works as an administrator for a restaurant company. “You can call 24/7, and they’re waiting for you. They’re like a big family.”

Dafoe credits the program’s improved outcomes and patient satisfaction to the coordination and commitment of everyone on the team.

“The surgeons, nephrologists, social workers, dietitians, pharmacists, nurse coordinators, data analysts, quality specialists, administrative staff — they all are enthusiastic and compassionate,” he says.

“We all know all the patients, their names, their faces,” Ichii adds. “And everyone knows the sweet Morales sisters.”

Giving the new kidney a name

The sisters even have a nickname for the transplanted kidney, “Nanichii.” They combined “Nana,” Xenia’s name for her big sister when she was too young to pronounce Nadia properly, and Ichii.

Naming the transplanted kidney was a first for Ichii, but he approves.

“They understand how important that kidney is,” he says. “Maybe all patients should do that. It’s an excellent way to appreciate the kidney keeping them alive.”

Since passing the two-year mark after her donor surgery, Nadia no longer needs regular follow-ups with a specialist. But she still accompanies Xenia at her quarterly checkups with Reddy, who invariably greets them with a cheerful: “Hi guys, how’s Nanichii?”

“Great,” the sisters respond in unison.

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