AGH Doctor Gets Gift Of Kidney From Son

By Christopher Snowbeck

Post-Gazette Staff Writer

Yesterday morning, just hours before he donated a kidney to his father, Federico Fragola walked into his parents' bedroom, video camera in hand, and captured their reaction to his unexpected wake-up call.

The film chronicled not just the waking moments of Dr. Jorge Fragola, the transplant recipient who is a kidney doctor himself, but also recorded the doctor's morning shave and his wife's sleepy farewell to her son.

The footage is part of the 24-year-old's ongoing video diary of his family's encounter with organ transplantation -- a story that culminated yesterday with surgeries at Allegheny General Hospital that could dramatically improve the quality of the physician's life and perhaps even extend it.

As he lay on a gurney yesterday with a bag of fluid hooked to his arm, the younger Fragola laughed about the morning filming, and talked more about the oddity of being an organ donor than the fear.

"I try to visualize it. I wonder what it all looks like," he said. "It seems surreal in a way that they're taking a chunk of me and putting it in someone else."

But the apprehension that Federico tried to hide with his comments was explicit in his father's words.

"I was reluctant to take a kidney from my son. Psychologically, I guess," said Fragola from his 11th-floor room at Allegheny General, as his son awaited surgery on the third floor. "I think you have to have children to understand that. You don't want them to have to go through anything, really."

Both men were doing well last night, said Dr. Marc Gignac, the transplant surgeon at Allegheny General who worked with the Fragolas. Federico should be out of the hospital in three to four days, while his father should leave in five to seven days. Fragola must take immunosuppression drugs for the rest of his life, but the hope is that after a year off work following the surgery, he will be able to return to a productive life.

Living Donor Advantages

Living-related kidney transplants are not rare. At the University of Pittsburgh, for example, there were 22 kidney transplants last year where the donor was a living relative. Allegheny General averages about 15 a year, although yesterday's was the first case of a son donating to a father since the hospital began transplanting kidneys from living relatives in 1987.

Donating a kidney carries some risks, but the risks are the same as those of any major surgery and there is a very slight risk of developing high blood pressure later in life. There's a less-than-5 percent chance of having a major complication with kidney donation and the chances of dying are remote.

It contrasts with taking a portion of a liver from a living adult donor and transplanting it to an adult with end-stage liver disease, which experts last year said carried a 30 percent chance of complications and a 5 percent chance of death.

Still, a son-to-father donation taps into a special set of emotions for every family involved in one.

"There's such a tremendous conflict," said Mary Ann Palumbi, senior director of transplantation services at Allegheny General. "While the parent desperately needs to get well, the parent doesn't want to put that child in the situation."

A native of Argentina, Fragola first visited the Pittsburgh area as an exchange student at Apollo-Ridge High School. When he completed medical school in the 1970s, he decided to complete his training at a residency program in Western Pennsylvania.

Fragola, who lives in Hampton, started working at Allegheny General Hospital in 1975. As a nephrologist, he cares for patients whose kidneys are failing and who must rely on dialysis machines to remove impurities from their blood.

Fragola was always interested in the physiology of the kidney, but didn't have a personal or familial connection with kidney disease until November 1998. After he experienced flu symptoms for a week, doctors determined that Fragola suffered from glomerulonephritis, a fairly common end-stage renal disease.

Gignac said it was impossible to know what caused Fragola's disease. He went on dialysis almost immediately and, weeks later, one of his kidneys had to be removed.

Doctor As Patient

In some ways, doctors make good patients, Fragola said, because often they are able to accurately describe symptoms to their physicians.

But not everything about it is great.

The biggest problem, he said, is that as a patient, "the more you know, the more you worry about it."

Fragola also suspected that some nurses initially might have felt awkward caring for someone who usually directs the care. But the physician said he was always careful to follow the advice of his nurses and doctors.

"I accept what my nephrologist tells me," he said. "I believe that if I'm my own doctor, I'll be mistaken. Your judgment is clouded. You lack a measure of objectivity."

The illness has taken its toll on Fragola.

With dialysis sessions taking place at night while he slept, Fragola was spared the frustration of sitting at a dialysis machine four hours a day, three days a week. But he still encountered problems faced by many dialysis patients -- a restricted diet, dramatic cuts in the amount of fluids he could drink and general fatigue that forced him to cut his work hours.

"He could have kept going for a while, but it was obvious that dialysis was not keeping him healthy," surgeon Gignac said. "Some people do better on dialysis than others and it was obvious he wasn't thriving."

Fragola tells his dialysis patients that getting a kidney transplant from a live donor provides the best chance for success. For a living person to donate, the donor must be perfectly healthy. As a result, the donated organs are generally in better shape than those recovered from a cadaver.

The other major advantage is that a living donor removes a transplant patient from the uncertainty of the country's organ donation system, where the supply of organs doesn't meet the demand, said Gignac. On average, patients with a live donor get transplanted sooner, Gignac said, and the surgery can be scheduled for when the recipient is in the best condition to receive the organ.

Despite all this, it was hard for Fragola to follow his own advice when it came to taking an organ from his son.

"I told him I'd rather wait and see if we got a cadaveric organ," Fragola said.

Eager To Help

For his part, Federico Fragola volunteered immediately to be a donor.

Initially he was told his blood type didn't match his father's, but nine months later the family determined there had been an error in the original test. A new one showed Federico could donate.

"We're a very close family," Federico said. "We'd all probably do anything for anybody else in the family."

A graduate of Hampton High School, Federico studied at the Art Institute of Pittsburgh and took classes with Pittsburgh Filmmakers. He moved to Las Vegas, Nev., to attend film school, and also works at a hotel there.

The night before surgery was sleepless for Federico, although he attributed that to the time change and his unusually late bedtimes. The highlight of the evening involved consuming four liters of laxative over the course of two hours to clear out his system for surgery.

"I spent my last night bonding with my kidney," said Federico, whose animated speech gives him a much larger presence than his 5-foot-6-inch, 135-pound frame.

In a more serious moment yesterday, Federico said of his dad: "It just kills me to see him like this."

Federico said he and his father are very different men: the father is worrisome, while the son is carefree; one graduated from medical school, the other is an artist.

But the father understands quite a lot about his son -- including why Federico started yesterday with a video camera.

"I think he does that because he's a little bit scared -- that's his way of getting over it," he said. "He's a very artistic and imaginative guy and I think to rationalize this, he treats it like an adventure."

Fragola said he hopes the story of his son's generosity will compel others to consider becoming donors themselves.

"I think it's important to encourage people to donate kidneys, not just the living-related but also otherwise, because like in my case a lot of people with rehabilitation will go back to work and have a productive life," he said. "I always felt that way and I feel more that way now that I feel it from the inside."

Copyright © 1997, 1998, 1999, 2000 PG Publishing.

This article posted November 2, 2000.