Here’s Looking at You, Kidney

How and why I became an organ donor— and how I kept people from talking me out of it.

UNTIL LAST NOVEMBER, I’D NEVER THOUGHT about being a kidney donor. I hadn’t known anyone with kidney disease, and like most people, I hadn’t filled out an organ donation form when I’d gotten my driver’s license. I’d never even donated blood. That all changed after I ran into a friend and asked, “How’s Sally?” I got an unexpected answer: “She’s . . . all right,” in a tone that made it clear she was most definitely not all right.

Sally Satel and I have been friends since 1997. We’re kindred spirits—strong-willed, intellectual iconoclasts who are a bit too ingenuous for our own good. But she lives in Washington, D.C., where she’s a fellow at a think tank, and I live in Dallas. We almost never see each other and communicate mostly by e-mail. We follow each other’s work but don’t share our day-to-day lives. Last fall, no one would have called us close.

So I had no idea Sally’s kidneys were failing. She needed a transplant, our friend told me. Otherwise, she’d soon be on dialysis, tied at least three days a week to a machine that would filter poisons from her blood. For someone who prizes her independence and freedom of movement as much as Sally does, dialysis would have been a prison sentence.

With no spouse, children, siblings, or parents to offer her a kidney, I thought she must be desperate. I knew the chances of getting a cadaver kidney were low, although I didn’t realize how truly minuscule : More than 66,000 Americans are on the waiting list for the 6,700 or so cadaver kidneys that are available each year. Just thinking about her situation made my heart race with empathetic panic.

“Maybe we can do something to get Sally a kidney,” I said. It probably sounded as if I were proposing a publicity campaign. After all, she and I and our mutual friend are in the persuasion business: We write books and articles and have lots of press connections. What I really meant, though, was “Maybe I can give Sally a kidney .” At the time, it seemed like a perfectly natural reaction.

Usually when someone is seriously ill, all you can do is lend moral support and maybe cook some meals or run a few errands. Nothing you do will make that person well. But if you donate a kidney, you can (with the help of a team of medical specialists) cure her. Who wouldn’t want to do it? I had no idea what a strange thought that was.

Nor did I sort through my motivations. I’ve spent a good bit of my life trying to save the world, mostly by working to beat back bad government policies, including some that would have stifled medical research. But even when your side wins, the victory is incremental and rarely permanent. And people of goodwill dedicated to the same good cause can be awfully contentious about how to achieve their goals.

In this case, there was something reassuring about the idea that the benefit wouldn’t depend at all on my talents, persuasiveness, or intellect. It would be simple. All I had to do was show up. In middle age, I’ve realized that I can’t save the world. But maybe I could save Sally. Someone had to.

Except for living in Texas, I was the ideal candidate. I was healthy, with no family history of kidney disease. Like Sally, I had no kids depending on me. (Unlike her, I had a big family of potential kidney donors, just in case.) I was self-employed, and my husband, a professor, had a fairly flexible schedule. Neither home nor work obligations would pose a problem.

But first I had research to do. I didn’t want anyone to know I was considering the idea unless I was absolutely sure I’d go through with it. I didn’t want to get Sally’s hopes up and then renege. That would have been worse than not volunteering in the first place.

An hour on the Internet told me what I needed to know. All a donor and a recipient have to have in common is a compatible blood type; anti-rejection drugs take care of the rest. For the donor, the operation isn’t especially risky or particularly difficult to recover from. Laparoscopic techniques have replaced the old side-splitting gashes with a few tiny holes and an incision two- to three-inches long, just big enough to slide out the kidney. The donor usually spends a couple of days in the hospital and, other than athletic exertions I’d shun anyway, can resume normal activities within a week or two. The main dangers are those of any major surgery: general anesthesia, bleeding, infection. They’re serious risks, but people go through equally tough operations every day for purely cosmetic reasons.

Contrary to what most people think, living with one kidney is basically the same as living with two. The remaining organ grows to take up the slack. Someone with a single organ is no more vulnerable to kidney failure than someone with a pair, because most kidney disease attacks both at once. The exceptions are injuries, of course, and cancer. I was willing to take my chances.

What about my husband? As I’d expected, he wasn’t thrilled with the idea of letting someone slice open his wife, and he was afraid of the tiny but real risk that I might die. He liked Sally but didn’t know her that well. He’s a rational guy, however, and he knows what sort of person he married. He said okay.

I sent Sally a quick e-mail, confirming that she did in fact need a transplant. She already had a likely prospect, she said. “If your lead doesn’t come through, let me know,” I wrote back. “If I’m compatible, I’ll be a donor.” After a couple more exchanges, Sally put me in touch with her transplant coordinator.

The first step to becoming a kidney donor, I discovered, is to give blood—the easiest way to find out

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