After a lengthy wait filled with ups and downs, including “kidney failure, fatigue and dialysis,”
John Kalmakoff of Regina has finally received a new kidney. The surgery took place on July 23 in Saskatoon.
Kalmakoff is originally from Canora, where his family has lived for many generations.
“I graduated from the Canora Composite High School in 1989 and attended the University of Saskatchewan where I received a B.A. and an L.L.B. in Law,” he said. “In 1998 I moved to Regina and have practiced law with the Saskatchewan Power Corporation Law Department since 2000 where I have served as a director, supervising five other lawyers.”
As an adult Kalmakoff discovered he had polycystic kidney disease (PKD), an inherited kidney disease that slowly shuts down kidney function.
“Three years ago, in July of 2017, I was advised that I had reached Stage 5 kidney failure,” he recalled. “Because of chronic fatigue associated with kidney failure, I was no longer able to work full time. For the next year and a half, I was able to perform peritoneal dialysis, a form of dialysis done at home on a daily basis. However, by early 2019, that form of dialysis ceased to work for me and I had to switch to hemodialysis, which was undertaken at the Regina General Hospital, three times a week for five hours each treatment for the next year and a half.
“Over the course of this three-year period, I also had to undergo several major surgeries related to my kidney failure, including three major hernia repairs, a nephrectomy, the removal of an enlarged kidney to make room for an eventual replacement kidney, as well as several smaller procedures, such as the installation of a catheter for peritoneal dialysis and a different catheter for hemodialysis.”
Throughout the past three years, his daily life was spent around dialysis, which took up a significant portion of his schedule.
“I also cared for my three children, Kate aged 15, Emily aged 12 and Jake aged 4 as a single parent. However, while the dialysis was keeping me alive, it was no substitute for a healthy, functioning kidney. By January of 2019, I had already been placed on a waiting list for a deceased donor kidney. However, the waiting time for a deceased donor kidney can range anywhere from days to (in most cases) three to five years or even longer.”
Kalmakoff began searching for a living kidney donor as well. That search had just begun around the time the Canora Courier published its first article about his situation.
“What the Canora Courier staff and its readers would not be aware of, however, is that the publication of the original news story in January 2019 had a most incredible and unexpected outcome. A resident of Canora, who out of respect for their privacy shall remain anonymous, read the Canora Courier article about my situation and was personally moved to come forward as a potential living donor.
Following an initial screening, where it was determined they had a compatible blood type, they underwent nine months of very detailed testing through the Saskatchewan Health Authority (SHA), and by December of 2019, it was determined that they were a fully compatible match and were cleared by a panel of kidney specialists and surgeons for a transplant.
“We were advised at that time that a transplant would be scheduled for between April and June of 2020.”
Unfortunately, before that surgery could take place, the global COVID-19 pandemic occurred.
In mid-March of 2020, cases of the virus had reached Saskatchewan and the province was placed under lockdown. As part of the lockdown, the SHA cancelled all surgeries and procedures deemed to be non-essential. Unfortunately for Kalmakoff, this included all kidney transplants with both living and deceased donors.
“My living donor and I understood that we would not be able to have the transplant until such time as they were resumed by the province. We assumed we would still be going forward; it was just a question of when.”
At that point, Kalmakoff’s story took an unexpected turn. The province had begun a phased-in reopening of the economy and provincial programs beginning in May. By July, the SHA resumed deceased donor kidney transplants but not living donor transplants.
“I was informed on July 10 that I had been placed back on the provincial deceased donor list,” he said. “Then just 12 days later, I got the call of a lifetime. On the morning of July 22, I received a call from a nephrologist (kidney specialist) at St. Paul's Hospital in Saskatoon. He told me that they had a deceased donor kidney that was a 'very close match' to my own at 95 per cent, that it was very rare to find such a close match, and that if I wanted it, I needed to proceed immediately to Saskatoon for a transplant later that day.
“After three years of my whole life being disrupted, it is difficult to put into words just how overwhelming it was to receive such a call, at long last. Suffice to say, three hours later, I was in Saskatoon and admitted to St. Paul's Hospital for a kidney transplant.”
The actual transplant took place on July 23 in a five-hour operation.
“The procedure went very well, and by the time I woke up mid-afternoon that day in the recovery room, the new kidney was already fully functioning within my body,” reported Kalmakoff. “It might sound hard to believe, but within a day of the surgery, I felt like a veil had been lifted, both physically and mentally. I felt stronger, more energetic and clearer than I had since I could remember, even as I was still recovering from a major surgery. I spent the next week after the surgery at St. Paul's Hospital where I was very closely monitored on an hourly basis, and began a regimen of anti-rejection drugs to ensure that my body did not reject the new organ. After one week, the surgeons, nephrologists and staff were sufficiently confident with my post-transplant recovery that they released me to continue my recuperation at home; even though many kidney transplant patients remain in the hospital for longer, up to 12 to 14 days.”
Since then, his recovery has continued from his Regina home on multiple different fronts.
“First, recovery has included healing from the 12-inch surgical incision through my abdomen. It is still a bit stiff and sore and I will continue to have lifting restrictions for another month, however it is healing very nicely.
“Second, recovery has involved closely monitoring the new kidney's function, which has required twice-weekly blood work and weekly visits with the post-transplant team of doctors and nurses assigned to my case. For the first week or two, as the body and new kidney adjusted to each other, if there were any discrepancies in blood chemistry, they were immediately treated by medication prescriptions or changes. My doctors are very pleased with how well the new kidney is performing.
“Third, recovery has involved taking large doses of the anti-rejection medications for the first three months after the transplant. These medications have to be taken twice-daily without fail.
“I have now completed the first month and have two more months to go. These anti-rejection drugs are vital immediately after the surgery to ensure the body does not reject the new organ. Unfortunately, one of the side-effects of them is that they temporarily render the body's immune system almost zero. Under normal times this can be managed, but in the middle of a global pandemic, it becomes absolutely critical to remain safe, as even a normally 'minor' infection can be life-threatening under these circumstances.
“Therefore the fourth aspect of my recovery has been being under lockdown at home by myself. I only go out when I absolutely have to, and then only wearing a surgical mask, having hand sanitizer on hand, maintaining social distancing and doing plenty of hand-washing when possible. I have friends who pick up groceries for me and deliver them on my front steps. My children are currently staying with their mother, since they are either in daycare or will soon be starting school and their interaction with other kids is currently a serious safety risk for me. We maintain daily contact through FaceTime, text and phone calls and we have had outdoor, masked and socially-distanced visits.”
At the end of three months, in approximately November or whenever he receives clearance from his nephrologist, the anti-rejection drugs Kalmakoff is currently taking will be significantly reduced; although he will have to continue taking a small dose for the rest of his life.
“At this time, my immune system will bounce back and resume at full or near-full strength. By the end of the year, I should be able to start normal activities again, including returning to work at SaskPower. Of course, at that time, the only 'wildcard' will be the state of the coronavirus outbreak in the province, which my doctors and I will continue to closely monitor.”
Due to privacy regulations Kalmakoff may never know the identity of the deceased donor of his new kidney.
“What was disclosed to me was that the person was a healthy male in his mid-twenties who died 'tragically' and unexpectedly. Whoever he was, he had the foresight and wherewithal to sign his organ donation card and advise his family of his wishes. Although his unexpected death was tragic, by signing his organ donation card and donating all of his organs, he saved the lives of up to eight other people, including myself.
“The SHA has a process for allowing deceased kidney recipients to write to the deceased donor's family on an anonymous basis. I plan to use this process to write the family to let them know how profoundly receiving a new kidney has changed and saved my life, how grateful I am every day for the opportunity, and how it has given me a new lease on life for myself and my family going forward.”
After this life-changing experience, Kalmakoff plans to become more involved in advocating for and promoting organ donation.
“This is possible both through living donations and/or by signing deceased organ donations cards at a provincial level. Saskatchewan still has one of the lowest rates of organ donation in Canada, and although the well-published example of deceased Humboldt Broncos player Logan Boulet's organ donation has greatly raised awareness in the province, we still have a considerable way to go. To this end, I have recently joined the board of directors of the Kidney Foundation of Canada, Saskatchewan Branch and look forward to continuing advocacy through that organization as well as on a personal level.”
Kalmakoff has an urgent request for Canora Courier readers.
“Please add an Organ and Tissue Donor sticker to your Saskatchewan Health Services card and sign the Intention to Donate card (available from eHealth Saskatchewan by calling 1-800-667-7551.) Talk to your family about your decision to be a donor, so they can support your wishes. Doing so can give the Gift of Life to up to eight other people. As someone who has received a deceased donor kidney, I can attest to just how profoundly life-changing, life-altering and life-saving this has been for me.
“Also, there may be some who may consider being living donors. The need for organs and tissue for transplants far outweighs the available supply in Saskatchewan. Becoming a living organ donor is one way you can help alleviate this need, and it may be a decision that’s right for you.
“Regarding my living donor, the fact that they were willing to come forward, donate a kidney and went through months of rigorous testing has been profoundly inspiring,” continued Kalmakoff. “And while circumstances prevented me from receiving their kidney, I am forever grateful for their selflessness and willingness to donate one of their kidneys, and through the process I have made an incredible new friend and 'honourary' family member for life.”
After his recovery, he hopes to be able to continue assisting his mother, Oney Pollock of Canora, in any way possible.
“She came to Regina to look after me after many of my surgeries and I hope to be able to repay that kindness and assistance. I inherited my kidney disease through her, a disease we both unexpectedly found out we have well into adulthood. Over the past year, Mom's kidney function has also reduced to the point of requiring dialysis, and in the future she too will require a kidney transplant. “
“I have also received an incredible amount of support from my father Larry Kalmakoff, my sisters Carrie and Janna and my grandmother Leona Pollock of Preeceville. I have received a great deal of support, encouragement and prayers from extended family and a wide network of friends, near and far. Some of my friends living in Regina have, since the COVID outbreak, assisted me by picking up groceries and delivering them to my doorstep. Others have brought baked and cooked food items during my recovery from operations, or have reached out and offered assistance.”
Throughout the ordeal of waiting for a kidney, Kalmakoff said he learned to deeply value his family and friends.
“It was difficult in the interim, trying to be an active single parent, but not having the energy levels I was used to having. But the whole experience brought my children and me closer together. We made the best of the situation and everybody pitched in to help. I remained positive and optimistic throughout the entire time through my own faith and perseverance, and through the kindness, support and prayers of a great many family and friends.”
Since his donor kidney was almost a 95 per cent match, Kalmakoff is optimistic regarding his health prospects for the future.
“And it is inspiring to hear stories about Saskatchewan residents celebrating their 20th and 30th anniversaries as transplant recipients. I hope to one day be able to celebrate the same!”
Kalmakoff is looking forward to returning to his career at SaskPower once his transplant recovery is complete.
“I also plan to continue to write and publish local historical articles about Canora and the surrounding district as I am able to,” he concluded.