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DURHAM, N.C. – A Fayetteville man who underwent a rare abdominal wall and intestinal transplant at Duke University Hospital had the equally rare opportunity to thank his organ donor’s family for their generosity and compassion.

“I have a new family now,” said Johnathan Nauta, who underwent the 14-hour transplant at Duke University Hospital on Oct. 12. 

The emotional meeting Thursday, Nov. 15, at the Trent Semans Center highlighted the unique bond between Nauta and the family of Marcus Scales, a 13-year-old Rockingham County boy who passed away. His family said the decision to share eight of the youngster’s organs, benefitting six lives, was affirming.

“When making the choice for organ donation it was not hard for us to say yes,” said Marcus’s mother, Sherry Scales. “We needed something good to come out of our bad situation. Doing this gave us the chance to keep parts of him alive in other people and at the same time give other people the gift of life.”

Their decision provided a lifeline for Nauta, 37, who suffered years of declining health after surgeries failed to repair intestinal obstructions, resulting in organ failure and severe damage to his abdominal wall that made additional surgeries impossible. 

“When he was transferred to Duke four years ago, he was in dire condition,” said Deb Sudan, M.D., division chief for abdominal transplant surgery in Duke’s Department of Surgery and lead surgeon for the intestinal transplant. “His community hospital had recommended the family consider hospice services.”

Sudan and colleagues, however, were able to stabilize him and begin the complex process of gaining the different permissions required to perform an abdominal wall transplant, which involves a large segment of skin, muscle and blood vessels required to accommodate transplanted intestines.

While not new, abdominal wall transplants are not widely performed, with only about 20 of the procedures reported since 1998, according to the United Network for Organ Sharing (UNOS), which oversees organ transplantation in the U.S. 

Like face or hand transplants, abdominal walls are in a special category called Vascularized Composite Allografts (VCAs), requiring additional approvals from UNOS for transplant center participation. 

Duke surgeons -- including Sudan, plastic surgeon Detlev Erdmann and abdominal transplant surgeon Kadiyala Ravindra -- planned and trained for years to enable Duke to become one of the few sites in the country where abdominal wall transplants could be undertaken. That approval came in 2017, in conjunction with a research program headed by Linda Cendales, who directs Duke’s VCA program. 

The Duke team’s preparation led to a surgical innovation that helped reduce the time pressure for conducting the two transplants at once. As with any transplant, surgeons must race to restore blood flow to the donated organ and tissues so that they stay viable.

Two transplant surgeries at once heightens this time pressure. As Sudan and her team worked to perform the intestinal transplant, Erdmann and his team simultaneously worked to create a separate source of blood flow through the abdominal wall to a blood vessel connection in the groin, which essentially eliminated the interference with Sudan’s team.

This innovation could make abdominal wall transplantation more accessible to additional kidney, liver and intestinal transplant candidates who would otherwise be rejected because of the poor condition of their abdomens.

“The team effort at Duke was instrumental for our success,” Erdmann said. “We opened the door to many, many more patients, and this is really something we wanted to share today. This is not about us, it is about the innovation we provided and hopefully it will help many more patients in the future.”

As the first abdominal wall transplant recipient in North Carolina and surrounding states, Nauta said the decision to move forward with the procedure was emotional, but one he felt confident about. 

A former sergeant in the Army (his injuries were not related to his service), Nauta had diligently worked to fight off infections and maintain the strength necessary to undergo the huge procedure. 

“This was one of the options that Dr. Sudan and her team came forward with,” Nauta said. “It’s mind-blowing to me. I would have never thought this is possible.”

Nauta also understood that his fate was linked to tragedy, so when young Marcus passed away and his parents, John and Sherry Scales, made the decision to donate his organs, he was overwhelmed with emotion.

“They have truly blessed me,” he said.

Marcus’s mother, Sherry Scales, said the dreams her son had for his future -- to join the military and ‘to be a YouTuber so people would have something else to watch other than TV” -- ended tragically without being realized.

But from her son’s early and heartbreaking death, she said, perhaps Nauta and the other recipients of Marcus’s organs could fulfill bright aspirations --just like Marcus would have.

“Marcus was loving and he was caring,” Sherry Scales said. “I know he would be pleased with what me and his father have chosen for him, since he can no longer be here with us. We’re just pleased to be able to extend his life through the other people and help give their families the chance to spend more time with their loved ones.”

Nauta said he is ready to begin his new life and fulfill those hopes. 

“Now I’m part of another family, the Scales family, and I’m truly blessed,” he said. He also thanked his Duke doctors for their skill and perseverance.

“I know Duke is all about Duke basketball, but I’d rather be on this starting team right here any day,” he said. “Dr. Sudan, she’s the Zion Williamson of the team. Dr. Erdmann be R.J. Barrett. I start at point guard, I’ll do that since I’m the small one. Dr. Cendales and Dr. Ravindra, they be the ones throwing up the highlights. I’m just blessed to be under their care. This is the team that represents Duke as a whole.”