“They told me I was a match,” Ferrel recalls, “and there was no hesitation. I wanted to be the one who helped her. It’s a blessing for me to be the donor who cures her disease.”

The Ferrel family are active ranchers from Panhandle, Texas, and accustomed to the small-town way of life. In January 2018, 14-year-old Jackie started to look a little puffy, Audrey said, and her behavior was off.

Audrey took Jackie to their local doctor for what they thought would be a routine diagnosis. Instead, they got a call from the physician’s office that would change their lives.

“We had barely arrived home when they called with the results — Jackie was in end-stage renal failure,” Audrey said. “They told me, ‘You need to get back here right now. We’re flying her to Cook Children’s.’”

Audrey and her husband, Ty, packed up the family and drove to Cook Children’s Medical Center in Fort Worth. Cook Children’s urologist and surgical director Blake Palmer, M.D., diagnosed Jackie with IgA Nephropathy, or Berger’s Disease, which has no cure. The disease occurs when an antibody called immunoglobulin A builds up in the kidneys. They become inflamed and lose their ability to filter waste from the blood, which can be fatal if not treated.

Jackie would need a transplant to survive.

Berger’s Disease usually progresses slowly over years, but the course of the illness varies from person to person. Its exact cause is unknown.

Medication can treat some cases, but transplants are often needed. Initially, Jackie was hospitalized at Cook Children’s for a month, but she was eventually able to go home on dialysis. She resumed activity and even began track season.

“She had an awesome track season. She did very well,” Audrey said. “In addition to that, she still participated in cross country, qualified for regionals, and played basketball and tennis.”

Despite her outward progress, Jackie’s internal condition worsened, and a transplant was needed to save her life.

In December 2018 Jackie was placed on the transplant list, and they received a call for a high risk kidney shortly after, however they declined, knowing Audrey would begin testing for a live donor transplant.

“She told us she was feeling great, she didn’t want to take a high risk kidney if she could hold out,” Audrey said. “I was convicted from the beginning that my kidney was going to be the one.”

The process for matching with and receiving a live kidney donation is extensive and requires multiple EKGs, various scans and blood tests to ensure the kidney is a match and the risk is low. Surgeons at Texas Health Harris Methodist Hospital Fort Worth, which has collaborated with Cook Children’s for years on various projects, evaluated Audrey to determine whether she would be a candidate.

“Over time dialysis becomes less and less effective,” Dr. Palmer said. “She [Jackie] was more ill on a day-to-day basis, really just not able to thrive or have a normal life like we’d expect a normal 15 year-old. But after this transplant, she is going to get all those things back.”

Audrey’s tests confirmed she was a match. The final CT scan determines whether a donor is compatible based on the placement of an artery.

“We got the final call while at a basketball tournament,” Audrey said. “I just asked, ‘When can we schedule it?’”

Because Audrey was an adult, the surgery to remove one of her healthy kidneys would have to take place at Texas Health Fort Worth. The kidney would be walked across a sky bridge that connects the two hospitals and implanted in Jackie by a surgical team at Cook Children’s.

“The collaboration between our two hospitals is something I’m really proud of. I know the clinical teams on both sides of that sky bridge are really proud,” said Dr. Tariq N. Khan, transplant surgical director at Texas Health Fort Worth. “It’s about bringing the best resources together, with the single focus being the best possible care to the patients we serve.”

Audrey and Jackie scheduled their transplant for Aug. 27, 2019. The sky bridge cut the time from hours to just minutes for the donor kidney to be delivered. With Jackie feeling fatigued and unable to participate with her teams and work with the family’s ranch animals, the transplant could not have been scheduled at a better time.

“Toward the end I didn’t feel well at all,” she said. “I was ready by the time all the testing was done.”

Jackie checked in at Cook Children’s the night before to begin pre-op preparations and Audrey arrived at Texas Health Fort Worth the next morning, both of them with an entourage of family and friends.

Dr. Khan began Audrey’s surgery at 7 a.m. and by 10 a.m. he was transporting the kidney to Cook Children’s with the Fort Worth Life Gift transplant team.

Dr. Palmer and his team at Cook Children’s were waiting with Jackie prepped in the operating room. They knew as soon as the kidney was connected and producing urine that the transplant was successful.

The mother-daughter pair spent two months recovering Fort Worth, before heading back to ranch life. They have both recovered and Jackie is slowly easing back into her routine as a typical teenager.

“Jackie is feeling awesome. She is able to attend church, youth group, and 4H events. She is also keeping books for the varsity basketball team,” Audrey said. “She has begun to exercise again and has had her first ride [horses] since the surgery. While she’s not cleared to go back to school and regular sports yet, we anticipate that she will be cleared to do so soon. We are blessed beyond measure and are counting them out loud for sure.”

Though Audrey can’t physically donate again, she would make the same decision if she could go back, and encourages others to consider doing the same.

“Being a live donor was the best decision I’ve ever made. It’s a gift, really,” Audrey said. “It’s giving life twice.”

“So I found out I needed to get a kidney transplant due to my Lupus and was recovering,” Gomez wrote. “It was what I needed to do for my overall health. I honestly look forward to sharing with you, soon my journey through these past several months as I have always wanted to do with you.”

With the news of Gomez’s transplant, we thought it would be a good time to talk about a kidney transplant surgery. Cook Children’s has been performing transplants for years. The most recent was just two weeks ago on a toddler. Robert Gillespie, M.D, is a nephrologist and medical director of the program.

To get a better idea of what is involved with a kidney transplant, we talked with Blake Palmer, M.D., a member of Cook Children’s Urology Program and a surgeon who performs the kidney transplant operations.

1. What is a kidney transplant?

Dr. Palmer:  kidney transplant is when someone whose kidneys are not working for whatever disease process (i.e. -Lupus for Selena) can be on dialysis for renal replacement therapy and do the job her kidneys are not doing to maintain her life and health or they can have a kidney transplant. A kidney transplant means we remove a functioning kidney from a donor (can be living or recently deceased) and surgically place the kidney in the patient. This requires connecting the artery and vein of the kidney to the patient’s blood system and connecting the ureter from the new kidney to the patient’s bladder so that the new urine the kidney makes goes into the bladder so they can pee again.

2. How is the decision made that someone needs a new kidney and what goes into the decision making process?

Dr. Palmer: First, you have to have poorly functioning kidneys to the point you need to be on dialysis because they have failed. Second, you have to be otherwise healthy enough to benefit from the transplant and be healthy enough to undergo the surgery and recovery process.

3. Who can receive a kidney transplant at Cook Children’s?

Dr. Palmer: You have to be at least 10 kilograms (about 22 pounds) and healthy enough with renal failure. We go all the way up to age 18. Kids who weigh at least 10 kilograms are usually 2 years at the earliest.

4. How long is the surgery and what is involved in the recovery period?

Dr. Palmer: Surgery is 4 to 6 hours long and as described above requires connecting the transplanted kidney blood vessels to person’s blood vessels and connecting ureter to bladder.

Recovery is 5-7 days in the hospital on average.

5. Selena Gomez needed an operation because of lupus. What are the main causes for children needing a kidney?

Dr. Palmer: Lupus is a rare type of renal failure cause and even more rare in the pediatric population. It is more common in adults. In kids, about 50 percent are due to urologic causes that they were born with like vesicoureteral reflux, posterior urethral valves or bladder anomalies. The other 50 percent are kidney problems and those can be congenital dysplastic kidneys to disease that come on later in adolescents that cause kidneys to fail. It’s usually very different types of problems for grownups, where the main reasons adults need a kidney transplant are hypertension or diabetes.

6. Selena had her best friend donate a kidney. How do we decide who the donor will be?

Dr. Palmer: It’ s very rare to have a non-family member donate. For most patients the donor will be a cadaveric, recently deceased donor. How the donor is decided goes through the UNOS matching system. LifeGift is our local organ sharing and procurement non-profit who coordinates this process for our region. 

7. What do you hope people learn from this news?

Dr. Palmer: Awareness that people in all walks of life and all ages are in need of donated kidneys. That it is a safe and common practice. That non-family members can donate kidneys as well. I have done two previous non-family member donations at a previous transplant program. Our goal is that 40-50 percent of our donations will be living related because our patients will do slightly better with a living donated kidney than a cadaveric. Although, they can do very well from both.

To learn more about organ sharing, visit the United Network for Organ Sharing.

Related Story: 8 Facts About Lupus

About Cook Children's Urology/Genitourinary Program

Cook Children's has opened the doors to a state-of-the-art pediatric urology center dedicated to treating kids with many different genitourinary conditions. Click to learn about this groundbreaking program. 

About Nephrology

Whether your child needs inpatient care, outpatient care, dialysis or even kidney transplantation, our nephrologists provide continuous care for children with kidney-related problems. Click to read more.

* Photo from Selena Gomez's Instagram.