Joyful and resilient, Michael has a successful kidney transplant after dual cancer diagnosis, other challenges
If you ask anyone who knows Michael Borg to describe him, you’ll probably hear the word “joy” right away. Now almost 4 years old, Michael is “just pure joy,” according to his mom, Tricia. “He’s very curious, loves music, loves to have an audience and be part of the action – and he has a really great smile.”
Michael has been defying the odds since before he was born. While he was still in the womb, his urethra – the tube that lets urine leave the body – became blocked. This backed urine up into his kidneys and damaged them severely. Although he had two surgeries while still in utero, he was born in January 2020 at M Health Fairview Masonic Children’s Hospital with kidney failure and, because his lungs did not develop adequately in the womb as a result of the obstruction, respiratory failure.
“We have a very strong pediatric kidney program at Masonic, one of the top in the country. Even so, Michael is one of the most complex patients I have ever cared for,” said Pediatric Nephrologist Scott McEwen, MD, PhD, who is also an assistant professor at University of Minnesota Medical School.
Because of the kidney failure, Michael needed dialysis from birth. By the time he was three months old, he also had a tracheostomy and was on a ventilator to support his lungs. Dialysis took 10 to 12 hours every night to complete – but until he could receive a kidney transplant, there was no other option.
“Once a child is on dialysis, we follow them closely with a multidisciplinary team including a dialysis nurse who acts as an all-encompassing care coordinator, physicians, a dietitian, and a social worker. We see Michael once a month as a team, bringing in other specialists as needed,” McEwen said.
“Michael’s nephrology team has been really amazing. They coordinate all his care, and the dialysis nurse is available 24/7 for any questions or concerns,” Tricia said.
Cancer first, and then a kidney transplant
“He has had a very long journey to transplant. He’s had some challenges, and he threw us some curve balls,” Tricia said.
One big curveball was being diagnosed with two different types of cancer beginning at 5 months old, one on Michael’s adrenal gland and the other in his liver. The cancer discovery pushed Michael’s kidney transplant well into the future, as he would have to be cancer-free for two full years before a transplant could be considered.
“Having incredibly good communication and teamwork is the only way to successfully manage a patient as complex as Michael is,” said Pediatric Hematologist/Oncologist Emily Greengard, MD, who managed Michael’s cancer care. Greengard is an associate professor with the University of Minnesota Medical School. “Fortunately, we have already established strong relationships and good communication across disciplines.”
Michael and his family were in the right place to get the seamless, comprehensive care they needed. M Health Fairview Pediatrics provides Minnesota’s broadest range of care across 60+ medical specialties. In Michael’s case, dozens of doctors and other staff members from our lung, kidney, transplant, and cancer care teams worked together as one united front.
The teams collaborated day to day through electronic health record messages and phone calls, punctuated by frequent meetings and rounds, as well as periodic mini-care conferences. When it was time to make bigger decisions – like whether to list Michael for a kidney transplant – the full team of more than 20 specialists, plus care coordinators, supportive care representatives, and Michael’s parents met in person.
“The specialists all know each other very well, and they anticipate needs, which is very impressive,” Tricia said. “They’ve really come to know Michael well, and the consistency has been such a gift. Having people who have been there since the beginning, so you don’t have to start at square one, is wonderful.”
He "had so much joy and positivity in his heart"
Once Michael had been in remission for two years, it was finally time to discuss a kidney transplant.
The team decided to go ahead with the transplant, even though Michael still had a tracheostomy for breathing support, which typically disqualifies patients from transplant because of the heightened infection risk. Transplant Surgeon Srinath Chinnakotla, MD, Surgical Director of Liver Transplantation and Executive Medical Director of Pediatric Transplantation, remembers meeting Michael.
“Before I knew he was my patient, I saw Michael in the elevator. Here was a kid with so much going on, medically speaking, who nevertheless had so much joy and positivity in his heart that he smiled and waved at me. It made my day,” Dr. Chinnakotla recalled. “When I saw him in clinic, I knew I wanted to do the transplant for him. Obviously, it was a very high-risk procedure with many technical challenges, but I was determined to do what I could to help him.”
In September 2023, Michael had the kidney transplant he had been waiting for. His father, Brian, was the donor. “Being Michael's kidney donor is my greatest privilege. The transplant team made my experience as seamless as possible. They were extremely thorough, easy to work with, and took great care of me,” Brian said. “It's an honor to be able to join Michael in his fight for life in a very tangible way, and I would do it again in a heartbeat.”
Today, Michael’s family and care team are looking forward to seeing him continue to grow and develop, now that the burden of nightly dialysis is gone and cancer is behind him. “We’re forever grateful to the team for being willing to take on a patient like Michael. There is no real handbook or map to follow for how to care for him. That posed challenges, but we’re beyond thankful that Michael’s teams collaborated so closely to determine the best way forward for him.”
