'I wanted Moira to live'

[Clark]

http://www.montrealgazette.com/news/wanted+Moira+live/5935878/story.html

'I wanted Moira to live'
By Bruce Deachman

There's a patch of skin, about an inch square, on the inside of Nola Johnson's arm just above the elbow, that was not there when she was born in September 1942.

It belonged once to her identical twin sister, Moira, but has been a part of Nola since 1958, when the Johnson twins — as everyone knew them around their Baie d'Urfé home — were 15 years old. The graft serves as a reminder to Nola of the historic accomplishment she and Moira were part of more than a half-century ago, when they became donor and recipient in the first successful organ transplant in Canada and just the third worldwide.

More significant, though, it acts as a living reminder of the sister and best friend who died in 1978, and of the 29 extra years Nola was able to give Moira.

Nola touches her arm when talking about it.

"It's very precious to me," she says.

Moira was sick and having convulsions, and was in a coma by the time she was taken to the Montreal Neurological Institute in the spring of 1958.

Her condition had declined quickly and without warning; doctors at the Neuro were baffled.

They asked Dr. John Dossetor, a kidney specialist at Royal Victoria Hospital across the street, to have a look. Dossetor, who years later co-founded the Kidney Foundation, ran tests that showed extremely high levels of nitrogen in Moira's blood. Her kidneys were failing.

At the time, dialysis was a primitive science, just a dozen years old and infrequently used. Kidneys had been successfully transplanted from living donors only twice before — both times at Peter Bent Brigham Hospital in Boston, and on both occasions involving sets of identical twins. Immunosuppressives, or anti-rejection drugs, had not yet been identified, and so only identical twins could share organs without rejection.

When it was discovered that Moira had an identical twin in Nola, doctors realized they might be able to save Moira's life by transplanting one of Nola's kidneys into her.

"My mother was supposed to ask me," recalls Nola, who now lives in the Ottawa suburb of Kanata with another of her sisters, Lynne. "She started to talk about the problem, but I had read something in the newspaper a few weeks before about a kidney transplant in Boston, so I volunteered right away. She didn't have to ask.

"My main concern was that I wanted Moira to live. Whatever we could do, whatever could be done, it didn't matter. I didn't even think about myself. I thought everything would go well, as long as Moira got my kidney."

There were legal concerns, however. At 15, Nola was too young to give her consent to the operation, while the ethics of removing an organ from a healthy person, regardless of the reason, were murky. Doctors at the Royal Vic took the matter to Family Court, where it was ruled that Nola could, indeed, give her sister a kidney.

"I still remember the feelings I had," Nola says, "and I had no qualms about doing it at all."

An array of tests got under way to prove the sisters were, in fact, identical. Their fingerprints were a perfect match, and the skin grafts exchanged on their arms healed without a problem.

The operation was scheduled for May 14, and Dossetor co-ordinated it, getting the kidney and vascular surgeons and their teams, as well as setting up the specialized laboratory needed.

Moira was extremely ill the night before, and doctors didn't think she'd make it through another.

Nola, meanwhile, suddenly began to think of her own well-being.

"I was more concerned about the pain, or what was going to happen," she remembers. "I didn't think about anything else. But then they must have given me something to relax me, and I was fine."

The operation took place early in the morning and went fairly smoothly, although not without incident.

"In addition to transplanting the kidney," recalls Dossetor, "which has an artery and a vein — sometimes two veins — there's the ureter, which goes down to the bladder. But the vascular surgeon who put in that kidney said, 'Oh, I wonder what this is. I don't suppose they need it,' and he cut it off, by mistake. That's when everyone saw a stream of urine come out where he chopped it off.

"He just made a mistake. He didn't think."

Fortunately, although Moira's kidneys were useless, her ureters were fine. The surgeon removed one and reattached it to the new kidney. (The new kidney, incidentally, was placed in the middle of her abdomen. Surgeons didn't remove her old kidneys until September and October of that year.) The snafu notwithstanding, the operation was a success.

"I was looking over the surgeons' shoulder when they put the new kidney in and hooked it up," Dossetor recalls. "And almost instantly, it started gushing yellow fluid. She passed 11 litres of urine in the first 24 hours, and we had to measure all this, analyze it, and put back the good stuff and throw away the bad."

The first thing the sisters did after the operation was ask about one another's health. Nola returned home after 10 days, Moira after six weeks. Both abandoned such physical pursuits as hockey and horseback riding, but otherwise lived normal lives. Both finished high school and eventually found work in Montreal in the service department of Reader's Digest.

In 1974, both were found to have kidney disease. Nola was told she would require dialysis eventually, but has managed to avoid that, despite her lone kidney now functioning at just 16 per cent.

Moira, meanwhile, went on dialysis immediately, but was found to have breast cancer six years later. She died of the cancer in 1987. Nola remained at Reader's Digest until her retirement in 2001, then moved to Ottawa.

"I'm really thankful that we were able to start things off," Nola says of their historic transplant. "When she knew she wasn't going to live long, Moira said she thought she was put here to help people, and felt she had done a good job because they learned a lot from it. She thought there was a purpose for her going through this, helping other people.

"Moira lived a good life for another 29 years," Nola adds, "and I always say that I gave her the 29 years and I felt really good about doing it. I had no regrets whatsoever of donating my kidney to her."