Desperately Seeking A Kidney

In the fall of 2005, I started my first online relationship. He was a 62-year-old retiree from Canada; I was a 49-year-old psychiatrist living in Washington. Beginning in early October of that year, we talked or e-mailed several times a week. This arrangement was novel to both of us, so our conversations were tentative at first, but we soon grew more comfortable, and excitement over our shared vision blossomed. After a few weeks, we decided to meet for a uniquely intimate encounter. After New Year’s, the Canadian would fly to Washington to meet me — at a hospital, where he would give me one of his kidneys. Thank God.

The author nearly two years after finally receiving a kidney.

My own kidneys were failing. On a steamy day in August 2004, I went to the doctor for a routine checkup. I was feeling fine, but a basic test revealed that my kidneys were shot, functioning at about 16 percent of normal capacity. One nephrologist I went to predicted that within roughly six months to a year I would need to begin dialysis. Three days a week, for four debilitating hours at a time, I would be tethered to a blood-cleansing machine. Even simple things like traveling to see friends or to give talks would be limited. This would very likely continue for at least five years until my name crawled to the top of the national list of people waiting for kidneys from the newly deceased. On average, 12 names, the death toll from the ever-growing organ shortage, would be scratched off the list each day.

A much better option would be to get a transplant from a living person. I had tried that and failed. Thus my plans for a rendezvous with a man I had never met. But shortly before Thanksgiving, he disappeared. I panicked. Everything turned to radio silence as my e-mail and phone messages went unanswered. Was I, a psychiatrist no less, crazy to have put my trust in a stranger who goes on the Internet to relinquish an organ?

Friends wanted to know why my kidneys were giving out, but there was no good answer. I didn’t have diabetes or hypertension, the most common causes of end-stage renal disease. My doctor’s theory was that my kidney damage may have been caused by a medication I had taken during my 20s. The one thing we knew was that whatever was destroying my kidneys did so stealthily. Like most organs, kidneys have impressive reserves, and the slower they deteriorate, the longer they can keep up a good front, maintaining blood pressure, balancing the salt and electrolytes in the blood and, of course, producing about one to two liters of urine a day. I remembered a line from “The Sun Also Rises,” when a drunkard is asked how he went bankrupt. “Two ways,” he answers. “Gradually and then suddenly.” That was how my kidneys went out of business too.

The obvious place to find a donor is your own family, but that was not really an option for me. My parents were not alive and would have been far too old to help me even if they were. I have no siblings and only three cousins; I hadn’t seen two of them since high school; and the third I see maybe once every two or three years. I couldn’t call out of the blue with this news. I could just imagine my relatives tsking into the phone, “You only call when you want something.” Indeed.

Theoretically, kidneys should be in booming supply. Virtually everyone has two, and healthy individuals can give one away and still lead perfectly normal lives. Yet people aren’t exactly lining up to give. At the beginning of 2005, when I put my name on the list, there were about 60,000 people ahead of me; by the end of that year, only 1 in 9 had received one from a relative, spouse or friend. Today, just under 74,000 people are waiting for kidneys.

I wanted my donor to be completely anonymous so I could avoid the treacherous intimacy of accepting an organ from someone I knew. I would have gladly paid someone to give me a kidney, but exchanging money for an organ is a felony in this country. Altruistic giving is the metaphorical bedrock of our transplant system. Organ donation, we are told, should be the ultimate gift: the “gift of life,” a sublime act of generosity. The giver — whether living or deceased — must not expect to be enriched in any way.

In late 2004, not long after I learned my kidneys were failing and a little over a year before I met the Canadian online, I told one of my best friends about my diagnosis. She and I first met more than 20 years before at the medical school at Yale, when I was finishing my residency in psychiatry and she was an instructor in the same department. Dr. Yale, as I’ll refer to her to protect her privacy, is a feisty blend of bubbly energy (last summer she made me ride the Cyclone with her at Coney Island) and intellectual seriousness (she is training to be a psychoanalyst). She immediately offered to check her blood type. I needed someone with type A or O, and in uncomplicated cases like mine, blood-type matching is usually one of the biggest hurdles to compatibility. Dr. Yale was type O. Presto!

She said she needed to talk it over with her husband but thought it would be fine. A week later, however, she said it wasn’t. “Giving you a kidney seemed a perfectly natural thing to do,” she told me. “I had the time, and I wanted to do what I could and in a clear way, far clearer than the vague helpfulness of say, psychiatry. But then I mentioned my plan to donate to a fellow alto at chorus rehearsal one evening.” As it turned out, the alto in question was no typical acquaintance: she was a transplant surgeon. My friend continued: “She was very surprised that I was planning to donate to a friend and then pulled an article out of her bag about hemorrhaging after donating.” The exchange set off a spiral of anxiety in Dr. Yale’s mind — What if my brother or kids need my kidney? What if I had complications from surgery? I’m sorry, she said matter-of-factly, and that was that.

I understood that my friend wanted to spend her kidney wisely. What mystifies me still is how she got so spooked. After all, Dr. Yale was a physician herself, capable of weighing the risks. The operation is done by laparoscope, leaving only a modest three-inch scar; she would have been out of the hospital after two or three nights. Most important, the chance of death is tiny — 2 in every 10,000 transplants — and the long-term health risks are generally negligible.

Sally Satel is a psychiatrist and lecturer at the Yale University School of Medicine and a resident scholar at the American Enterprise Institute.

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