Overcoming All Odds for A New Kidney

In September 2020, Ann Foti, 60, became a living kidney donor for her husband, Gino, 63, who had been undergoing dialysis treatment for two years to manage his diabetic kidney disease. Once it was clear Ann was a match, she was determined to undergo surgery to help her husband.

“There was nothing that was going to stop me from giving him my kidney,” said Ann. “Through faith, I knew that this was meant to be. I could not see my husband on dialysis anymore.”

The Fotis received care from a multidisciplinary team of specialists at the Massachusetts General Hospital Transplant Center; however, because of complications with Gino’s condition and the onset of the COVID-19 pandemic, the journey toward transplantation surgery was far from simple.

The Journey to A New Kidney

Gino was diagnosed with diabetic kidney disease in 2018. When he first saw a kidney specialist at another Massachusetts hospital, he was already experiencing severe symptoms including yellowing of the skin, fatigue and low energy. The doctor told him he needed dialysis right away.

“He was so sick by that point,” said Ann. “He couldn’t walk to the bathroom. There was a point when we thought we were going to lose him.”

For two years, Gino traveled three days a week from their home in Tewksbury, MA, to the hospital where they received care at the time to undergo dialysis, with the hope that he would one day receive a kidney transplant. His care team recommended living donation as the best option for receiving transplantation surgery in a healthier, faster way. So, in tandem to his treatment, Ann and Gino underwent evaluation to determine if they were a match for a living kidney donor exchange.

When they learned they were a match, Gino’s and Ann’s hopes were high. However, after additional testing, they received unexpected news that changed the course of treatment—Gino was diagnosed with vascular disease. Ultimately, his care team deemed his case too high risk to perform the surgery.

Despite the setback, the last thing that Gino and Ann did was give up hope.

“It was the biggest devastation because we had thought we were right at the end, getting ready to book surgery, and then he was disqualified,” Ann said. “But I called Mass General and had all of our files sent over. The team there took him on.”

Finding New Hope

“I could see in their eyes that they believed they could perform this surgery with success. They were ready to take a chance where others would not.”

Ann Foti
Living Kidney Donor

In December 2019, Gino and Ann traveled to Mass General to meet with a team of specialists at the Transplant Center, which included:

• Nahel Elias, MD; Gino’s transplant surgeon
• Tatsuo Kawai, MD, PhD; Ann’s transplant surgeon
• Hannah Gilligan, MD; Gino’s nephrologist
• Kassem Safa, MD; Ann’s nephrologist
• Glenn LaMuraglia, MD; Gino’s vascular surgeon
• Kelly Herdman, RN; living donor coordinator
• Michelle Scala, RN; recipient coordinator 

Upon review of his records, the Mass General care team determined that they would move forward with scheduling his surgery, but not without concerns.

To ensure Gino could successfully receive the donor kidney, Dr. LaMuraglia would attend the operation to work on the blood vessel prior to transplantation.

“Dr. Elias explained the complications, but also told me that it was not his first rodeo,” Ann said. “I was scared, but I could see in their eyes that they believed they could perform this surgery with success. They were ready to take a chance where others would not.”

A Comprehensive Evaluation

After undergoing lab work—a standard part of the process to determine if the donor is healthy enough to donate her kidney—Dr. Safa noticed that the calcium levels in Ann’s blood and urine were high and recommended a neck ultrasound.

Ann was diagnosed with hyperparathyroidism, a condition that causes calcium to be released from the bones and travel through the blood. When it eventually routes through the kidneys, there is an increased likelihood of developing kidney stones.

So, before she could donate her kidney in a healthy way to her husband, Ann had to undergo surgery to treat this condition.

In the Midst of a Pandemic

In March 2020, the COVID-19 pandemic caused Mass General to pause many procedures, including theirs. And just a few weeks later, Ann, an activity director at a local nursing home, was diagnosed with the virus herself.

Ann quarantined and recovered from COVID-19 for the following weeks. She remembers the thought of passing it to her husband as the frightening part of the experience. Thankfully, he did not contract the virus, but Dr. Elias and the care team wanted to be as safe as possible as they considered the surgery.

“It is not something that we, or anyone really, had done before. So, we did not know if there would be complications with the kidney,” Dr. Elias said. “We consulted heavily with our infectious disease (ID) team. It is one our strengths at Mass General to have access to so many experts in one place.”

Ultimately, the team observed Ann’s health throughout her recovery and decided, based on best evidence and insight from the ID team, that she could move forward with the donation. And so, the couple decided to press on.

Ann underwent a successful parathyroid surgery. A few weeks later, her calcium levels were normal and the couple was cleared for surgery.

On the Day of Surgery

Finally, in September 2020, Gino and Ann were admitted to Mass General for their long-awaited transplantation surgery. While typically living donor surgeries can occur simultaneously, Gino’s surgical care team first had to determine that he was healthy enough to receive Ann’s kidney.

“Gino’s diabetes and vascular disease meant that he was higher risk,” said Dr. Elias. “While living donation is the preferred option as it generally means a healthier organ, the downside is that you get fewer blood vessels from the donor organ—which would have benefitted someone in Gino’s position.”

This meant that vascular surgical expertise was needed alongside the transplantation surgical team in the operating room.

While Gino was in the operating room, Ann waited in her hospital room for the green light from the care team.

“I was waiting on edge while they assessed Gino,” Ann said. “They came in eventually and told me that the damage was very extensive, but ultimately they felt confident moving forward with giving my kidney to him.”

Despite the uncertainty that morning, Ann and Gino underwent surgery and left the operating room grateful to have it behind them.

A Challenging Recovery

The days following surgery, Ann recovered quickly and was back on her feet in a couple of days. As the transplant recipient, Gino’s recovery would be longer. But nearly two days after surgery, he experienced significant difficulty breathing and increasing respiratory distress. The following day, he was placed on a ventilator.

“Dr. Elias kept assuring me that Gino would be okay,” she said. “Mass General was absolutely amazing. I was a mess at that point and the whole team was so reassuring.” After 48 hours, Gino’s breathing stabilized and he was ultimately able to regain enough control of his breaths to be removed from the ventilator.

Through the first few months of recovery, Gino continued to experience some labored breathing and struggled in adjusting to the medication. However, now five months later, Gino is recovering well and continues to receive follow-up care from his Mass General team through both in-person visits and telehealth.

To this day, Ann said, the confidence and compassion shown by her care team stays with her. “The day we walked through the doors at Mass General, we knew that we were where we were supposed to be,” she said. “The whole team took a chance on us and gave us our life back. They were honest while also comforting. They were a godsend.”