Before I had even thought about an organ donation, I was very active in endurance sports. As a career military officer, fitness is part of the job description. In addition to staying fit for work, I participated in Ultramarathons, long-distance cycling and mountain biking, orienteering, adventure racing, and kayaking. My military annual fitness test was a 1.5 mile run, a minute of push-ups, and a minute of sit-ups. Leading up to January 2017 when I had a kidney removed, I had been doing multi-day adventure races (mountain biking, paddling, trekking, climbing) across the US and internationally. My United States-based team had been the US Adventure Racing Association’s #1 ranked team in the annual points race 4 years in a row. I also hold a CrossFit and CrossFit Endurance instructor certifications and used CrossFit to supplement my endurance cardio. My resting heart rate was in the 40s.
I learned of a college classmate that was sick due to kidney problems in the summer of 2016 via our West Point class private Facebook page.
He had gotten sick several times since the diagnosis of November 2015 and had been on dialysis for about a year. He had blood sepsis once while on dialysis and had come close to death. He was on a waiting list for a kidney with no help in the foreseeable future. He had gained a lot of weight and was not tolerating the dialysis well.
The Facebook post was not by him, as he was too shy to ask for help from our class. But another classmate knew of his condition and posted it as none of the family members were good candidates to donate, and his options were now to wait for an organ from the state list. That could take up to 7 years.
I was stationed at the Pentagon at the time, a Colonel on active duty in the Air Force. I thought to myself “it’s easy to get my blood drawn and tested. Very likely I won’t match, I will have done my part.” So that is what I did, and didn’t mention it to my family or at work. After the hospital (Brigham and Women’s in Boston) had requested several more blood tests from me, my military doctor wanted to know about these tests. I told him they were for matching to a kidney recipient, and he suggested I ask the hospital if I was a good candidate based on all the testing so far. I asked in the early fall of 2017 and they told me yes; not only that, but I was the only volunteer still a potential match. All the others (I don’t know how many) were not acceptable candidates or dropped out.
At this point, I had to tell my wife, which was not the immediate support I had expected, and to see if the military would even allow me to donate and if there were any career impacts to doing so. For example, the military won’t let you deploy to hazardous duty zone unless you are medically cleared.
After talking my wife around, which didn’t take long after the initial shock wore off, the more difficult problem was getting the OK by the military. It turns out the military has a regulation on organ donation and it’s very supportive of members who want to do so. But, like in any large organization, the paperwork and approvals could be tedious and slow. It helped that I was working in the Pentagon, the headquarters of our military and that my military doctor was very supportive. After about a month I had approval. That was around early November.
All this time the kidney recipient, my West Point college classmate and former Army Officer, Chris, was not told the names of the volunteers or why some were dropping off the candidate list. The nurse I communicated with at Brigham and Women’s said this was to allow a volunteer to change their mind at any point, and the potential recipient not to have any knowledge of who or why the candidate was no longer under consideration. That is great protection for us volunteers since as the procedure date gets closer life can change. You could find out a complication about the procedure, you could have a birth or death in the family, a divorce, or just have second thoughts as the surgery day gets closer. Lots can change over a few months.
In my case, once I knew I was cleared as a candidate, and it was for somebody I knew from college, I ask my name to be shared immediately. Of course shortly after I received a call from Chris and his wife, and they were brought to tears with gratefulness at my volunteering to donate. It was a very memorable phone call, and one you don’t want to have until you are 100% sure about donating.
Leading up to the surgery, I had to travel to Boston for some testing. These included more blood and creatinine tests. They took so many vials of blood that the original needle stick stopped up, and they had to prick my other arm to fill all the vials. I hate needles, but this was not hard to put up with knowing why they were sticking me. They did an EKG, imaging of my kidneys, and a few other tests. Turns out I had some cyst in my right kidney, something not uncommon, and while they typically remove the left due to simplicity in surgery, they now changed the plan and wanted to give Chris my right kidney to ensure I kept the healthiest. I don’t know much about the difference in surgeries, but recall the doctor saying this added some risk to my surgery, as they needed to access blood vessels close to the spinal column in the removal of the right where an accident could be a very bad day for me. Otherwise passing all of those tests and questioning my mental health and kidney doctor staff, I was ready to set a surgery day.
Setting the surgery day was important for me. I lived in Washington DC and didn’t have any family in Boston, so I needed plane tickets, a hotel for me and my family, and a ride back to DC as I could not fly on a plane afterward (too hard on the abdominal muscles). I also needed to coordinate time off of work, with the likelihood of being out of the office for up to six weeks and even after that having limited capacity while I continued healing. On the side for Chris, he needed the kidney as soon as possible. Who knew when he would get sick again, or even die, waiting for a healthy kidney.
We planned the surgery over the December holiday break. But as we got closer, the hospital had to change the surgery date into early January due to a higher priority patient. We had to re-do plane tickets and hotel reservations. So, keep in mind the hospital priority may change and make reservations that you can update! And the travel costs are borne by you, Chris’ insurance didn’t cover that. Chris understood that and was financially able to pay for our hotel bill…they are expensive in downtown Boston! But expect that even as a donor, you will have expenses from this and they could be considerable.
I arrived three days before the surgery and checked into the hospital for some final tests and counseling. Again I had the option to change my mind, no questions asked. Not an issue for me, but there was a patient advocate nurse who was in my court and ready to help me walk through that debate if I needed it.
For the surgery day, I was admitted and checked in, then given some medication to settle my nerves. Once relaxed, they set up an IV and I waited a little while. I think there is some synchronization with the recipient’s surgery timeline and the donor’s, as we have separate surgical teams, but at some point, they added some medication to my IV and I was out in seconds, wheeling me down the hall to surgery. My last conversation with my wife was going over my will, and what to do if I didn’t wake up. To me, that was a real possibility, and I wanted to ensure she understood my immediate thoughts. People die in this surgery, not often, but it does happen.
I woke up what seemed like seconds later, and as I grasped the fact that I was alive and out the other end a feeling of gratefulness washed over me. I had about 8 nurses swarming me, and my wife said I was flirting like a high school boy with them all. I guess the medication has some side effects! I asked how Chris was doing, but his surgery was still ongoing.
The pain medications giving in the IV are incredible. I had a button to press that allowed me to get more. It was quite bearable, much less pain than I had mentally prepared myself for as I have never had major surgery. The nurses took me up to the top floor of the recovery area, into what I was told are the most expensive patient rooms in the hospital. I was told that for organ donors, the hospital does this if a room is available. It was private, with a good view of the city, and I had the best nurses.
It’s been 2.5 years now and I’m recalling those first few days over some time, but the first night I remember just going in and out of sleep. The next morning I was encouraged to get up and walk, dragging my IV cart along. I needed help to sit up and then stand up. We found the easiest way was for my wife to bend over the bed and hug me, then pull me upright so I was sitting. She could then pull my legs over the side of the bed, slide me to the edge, and pull me up. Once standing I found walking was not difficult but needed to be done VERY slowly with small steps. Getting back in bed was the reverse of the process, and we used these techniques for the next several weeks as getting up and getting down was some of the most difficult movements for me.
Soon I walked down to see Chris. He was in a shared room, much smaller than mine. He was also not recovering nearly as fast, as my small kidney-sized incision and laparoscopic incisions were minor compared to the much longer abdominal incision he had to receive, and his surgery was longer. I was also in perfect health going in, and he, of course, was not. But the good news was that no rejection so far, and he was recovering as could be expected.
At the end of day two, I had decided enough with the IV drugs. I was feeling pretty good and could handle the pain. I also didn’t want to use any more painkilling drugs than necessary. So I stopped and switched to taking pills of OxyContin.
That was a big mistake. I didn’t realize how strong the IV meds were, and how relatively weak the pills were in comparison. Shortly after stopping the IV meds I began to have major pain in my abdomen. I was sitting with my wife working on a puzzle, and she recalled me turning white and going downhill fast. She helped me to my hospital bed, and I curled up into a fetal position. I should have stayed on the IV for another day, as about 24 hours later I finally was able to handle the pain with just the pills and could get up and walk around again. But that was a very long day and unnecessary pain. Don’t be a hero here, people!
Chris came through surgery well, and the kidney was accepted by his body. Sometimes that isn’t the outcome, and mentally I had to prepare for his body rejecting my kidney, or having some other serious surgical complication…to include death. I was thrilled to hear his good news.
I left the hospital as soon as I was able, about 72 hours after surgery. I walked a few blocks to my hotel, as I could not get in and out of a car yet. It was a VERY slow walk, and I was still in hospital clothes. Kind of a freak show in downtown Boston, but I could have cared less. Every step was about getting my foot down in a controlled motion, leaning on my family members for support and not igniting a flame of pain in my abdomen. I wanted a real bed, and to be away from the germs that you can find in a hospital, resistant to drugs and deadly to those with weakened immune systems.
I stayed near the hospital for a few days, then was approved to leave but could not fly on a plane. While Chris and his wife offered to order a limo to drive me from Boston to DC (wow!), my mother also lives in DC and drove me home in the back of her minivan. That worked fine, and eventually, I got home. Potholes were no fun.
Home life was much easier, the biggest issues were getting up/down from the bed and anytime I forgot to be careful and used my abs (ouch!) I started to get the itch for returning to work after about two weeks, but knew I needed to continue resting. After a month I decided to head back, working a few hours and coming back home. Working was fine, but the commuting and getting to/from my office was the challenge. Abs are used in many ways we don’t think about normally, like walking up and downstairs, pulling open a heavy door, when somebody bumps into you on a crowded subway, or you drop something and have to pick it up. Once I was at work, sitting at my desk and using a keyboard was trivial. But I did tire quickly, and just a few hours per day for the first week was all my body could tolerate.
About week 6 I was returning to work full time, only leaving early if I was getting too tired. I was still sleeping quite a bit, about 8-10 hours per night, and feeling tired. I had stopped taking pain medications a while back but understood my body needed 6 months to fully heal and the remaining kidney needed about a year to take up the extra work from the removed kidney…at least as much as it could. I also had several appointments with my local doctor for drawing blood, creatinine tests, and verify the surgical wound was healing properly.
I had worried that being out of the office for a month would have my co-workers grumpy at me, as they had to pick up the slack. I was very surprised to see the opposite, they encouraged me to stay home longer, threw a party for me once I was back full time, and were extremely generous with opening doors and carrying heavy things until I was fully healed.
I walked during the second month of recovery, as anybody knows the Pentagon is a great place to get miles of walking in. Pushing open heavy doors still was hard. Into the third month, I was running and resumed racing. I won a 6-8 hour adventure race unofficially (running, mountain biking, and paddling a canoe), as I could not do the paddle portion but ran around the lake to collect checkpoints instead, still beating all the teams that paddled. The race involved lots of strategies, so I made up time with good decisions over the faster runners and bikers as I was not at top form yet.
I next ran a 40-mile ultramarathon in West Virginia in May, not with a competitive time but finishing. I resumed paddling and other core workouts in June. By August I was fully capable and competed in the Adventure Racing World Series World Championship 6 day race in the mountains of Wyoming. Again, my team finished but I needed to sleep more than normal (these races go non-stop, competitors sleep as needed) and still felt the impacts from only having one kidney.
After my 1 year checkup, when the remaining kidney was larger and higher efficiency, I noticed less need for extra sleep. I avoid NSAIDs, take caution to ensure I have extra water in hot events to avoid dehydration, and still need to get 8-9 hours of sleep on an average night.
I continue to adventure the world, some highlights include: summiting Mount Rainier, Mount Whitney, Mount Russell, Mount Democrat, and other US 14,000+ peaks; climbing Mount Taapaca in Chile (19,200 feet), several ultramarathons up to 50 miles on trails and in the mountains (Antelope Canyon was a favorite), bike packing the Great Divide Mountain Bike Route (GDMBR) a 2,500 mile trail from the US/Canada border in Montana to the US/Mexico border in New Mexico over 39 days.
In March of 2019, I entered the 72 hour Sea to Sea adventure race as a solo racer, and won 3rd overall finishing with only 1 hour of sleep over three days. A few weeks ago I traveled to Croatia for an Adventure Racing World Series 4.5 day race, trekking, kayaking, and mountain biking through the beautiful countryside and the Adriatic Sea. Soon after I won my third race since the donation, an 8-hour adventure race in Virginia. Later this year I will travel to Costa Rica for the La Ruta 3 day stage mountain bike race from Pacific to Atlantic coasts known as the toughest MTB race in the world, then head to Africa in January to climb Kilimanjaro, and to China in April to climb Everest via the Northern Route.
As a competitive athlete, I had prepared myself for giving up competitive sport after donating a kidney. At a minimum, I would likely be participating but no longer competitive. At just about three years after my surgery, I’m getting back on the podium for races from hours to multiple days and really not feeling any handicap from having just one kidney. Chris continues to feel well and is back to living a near-normal life.
One thought I’ve never had following the surgery is any regret. I would do this again today if I had another organ to give.
Col (Retired) Dave Ashley, US Air Force
Team US Military Endurance Sports
Team Rev3 Endurance