Thomas Spagnolia, M.D., Ph.D.

It's likely few medical professionals would be able to empathize so closely with patients as Thomas Spagnolia, M.D., Ph.D., a neurosurgeon from Bismarck, North Dakota. Dr. Spagnolia, who developed Type 2 diabetes while in his 20s, thought that his condition was under control until 2002, the year he turned 53, when he began experiencing the first of a series of medical complications related to the disease.

"I had bleeding in my right eye," says Dr. Spagnolia. "I went in to see my doctor and learned I had diabetic retinopathy."

Diabetic retinopathy is a severe reaction of the eyes to diabetes in which one's retina creates abnormal vessels that bleed easily. Dr. Spagnolia underwent a laser photo coagulation and later a delicate operation called a vitrectomy to strip the retinal membranes of scar tissue in order to improve his vision and prevent possible blindness. After surgery, Dr. Spagnolia's recovery went well. He regained normal vision, although he experienced some permanent loss of peripheral vision, which is common with the laser procedure.

Kidney Begins to Fail
Dr. Spagnolia was able to return to a full work schedule just four weeks after surgery. However, he began feeling chilled much of the time and wasn't able to get rid of an unusual salty taste in his mouth.

"I met with my physician who told me that my body had four times the normal level of creatine and that my potassium level was abnormal," he says. "This meant that my kidney was failing."

Dr. Spagnolia's physician believed he was in need of a kidney transplant, and referred him to Mayo Clinic in Rochester, Minnesota.

Diabetes the Number One Illness that Causes Kidney Failure
At Mayo Clinic, Dr. Spagnolia met with Thomas Schwab, M.D. a nephrologist. (Nephrology is a branch of medicine dealing with the function and diseases of the kidney.)

Diabetes is the number one medical illness that causes kidney failure in the U.S. However, Dr. Schwab believes that there are ways diabetes can be managed to help avoid the need for transplant.

"The key is to optimize blood sugar, blood pressure control and the patient's cholesterol and lipids," says Dr. Schwab. "In my career, medical advances to control those three parameters have greatly decreased the complication rate of diabetes."

For those whose disease does progress, however, Mayo Clinic is considered one of the top kidney transplant programs in the nation; approximately 200 kidney transplants are successfully performed there each year.

Finding a Donor
If Dr. Spagnolia could not find a donor among his family and friends, it was likely that he would face a long wait for a donor. Currently, nearly 75,000 candidates for kidney transplants are on a national waiting list, and the unfortunate fact is that many people do not receive a compatible kidney from a deceased donor in time.

Dr. Spagnolia's wife, D'arcy Honeycutt, also a physician, wanted to donate, but had an incompatible blood type (while not required it is preferred that donors have matching or compatible blood types); ultimately, it was Dr. Spagnolia's sister-in-law, Stacy Honeycutt, who had a compatible blood type and offered to be a donor. The family members made the trip to Mayo Clinic in January 2003 to prepare for surgery.

A Good Match
At Mayo Clinic, Dr. Spagnolia and Stacy were evaluated for their suitability for a successful transplant, passing through a series of thorough medical tests in order to be accepted for surgery. (To make the process easier for patients, some customary health maintenance screening tests, such as a colonoscopy, can be performed at a local hospital before coming to Mayo Clinic.)

Additionally, patients and donors meet with a transplant surgeon, a social worker, a medical financial consultant, a dietician, and a transplant nurse coordinator in an evaluation period that may take three to five days.

Together with the nephrologist, this team of medical experts reach a consensus as to the patient's and the donor's eligibility and suitability for transplant. Dr. Spagnolia and Stacy were considered good candidates and surgery was scheduled for April of 2003.

Transplant a Success
The surgery involved a hand-assisted laparoscopic kidney removal from Stacy, which lasted about two hours. Then the donor kidney was flushed and transported to Dr. Spagnolia's operating room, and transplant surgery was performed.

Kidney recipients generally stay in the hospital for four days after surgery, then stay at the Gift of Life Transplant House or a hotel in Rochester as outpatients for an additional two weeks where their progress is closely monitored.

"It was amazing after the transplant," says Dr. Spagnolia. "I felt warmer, finally stopped feeling nauseous, and no longer tasted salt in my mouth."

Maintaining Healthy Lifestyle Is Key
Dr. Spagnolia continues to meet regularly with Dr. Schwab.

"Part of the transplant process is trying to help the patient make positive lifestyle changes," says Dr. Schwab. "This includes correcting obesity, maintaining a diet low in fat and cholesterol, as well as a diet that will contribute to normal blood pressure, which needs to be monitored at home. The new kidney isn't a solution in of itself — the diabetes is still there and history can repeat itself if the patient isn't careful."

Dr. Spagnolia followed all Dr. Schwab's recommendations and his health was excellent for several years.

New Complications Arise
Dr. Spagnolia continued to experience good health until 2006, when he had to have another vitrectomy on his left eye; then, later that year, he developed a diabetic ulcer on his left foot that was not healing properly.

"My doctor said that it might lead to an amputation," he says.

Dr. Spagnolia was found to have a blockage in the left femoral artery. He underwent a Silverhawk procedure, which opened the artery up, and his left foot healed completely. To better control the diabetes and reduce the further development of peripheral vascular disease, his local doctor recommended that he have a pancreas transplant. He went back to the Mayo Clinic for further testing and was considered for a pancreas transplant.

Unlike a kidney transplant, a pancreas usually cannot be donated by a living donor, so the only option is to be added to a waiting list for a pancreas from a deceased donor. Dr. Spagnolia was prepared for the usual one- to two-year wait, but only six months later received a phone call informing him that there had been an accident, and, as a result, a pancreas from one of the victims was available.

"We had to get from Bismarck to Rochester in 12 hours," says Dr. Spagnolia. A friend who was also a pilot flew Dr. Spagnolia and his wife to Rochester and surgery was performed by a team led by Mark Stegall, M.D.

"It's a Totally New Situation"
Today, Dr. Spagnolia reports that he is feeling better than he has in years.

"For more than 20 years, I have been on insulin," says Dr. Spagnolia. "Now, I no longer need to take it and can even eat a normal diet. I check my blood sugar levels two times daily and twice weekly."

Once his body's blood sugar levels are consistently proven to be normal, he hopes to realize one of his lifelong dreams: getting a pilot's license to fly helicopters, something which, as an individual on insulin, he previously could not consider.

"I'm ecstatic. Things have reversed," he says. "It's a totally new situation. I feel like I've become free."