I would end the calls blubbering with gratitude: The psychology of kidney donors and recipients

Dr. Sally Satel's story:

My 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% 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.

In October 2005, I stumbled across a web site called MatchingDonors.com that helps link potential donors and recipients. I wrote only a short self-description.

Three days later, a Canadian man called. He told me he considered becoming a donor five years ago when he heard through his church about someone who was failing on dialysis. That was the most personal thing I learned about him. Well into November, we were in regular contact, mostly about logistics – whether my insurance would pay for his tests, whether he could take time away from a project he was working on, and so on. I ended the calls blubbering with gratitude, and he would tell me to stop.

Until both of us were snug in our adjoining operating rooms, I could never relax – everything was tentative, conditional, and prone to collapse.

About a week before Thanksgiving, the Canadian went dark. By then I was fatigued most of the time and fluid was pooling in my ankles. I took four antihypertensive drugs a day and had injections of a hormone that stimulated my body to make more red blood cells. Dialysis was closing in.

Around Christmas, he finally called. He swore he was still "raring to go with the transplant." A few days later, my young transplant coordinator, Julie, called him. Straight talking and bright-eyed, she spoke to him in a way I could not. "We need to know how to proceed," she told him firmly. "There is no time to spare. Can you be here in January for the surgery?" He conceded that the campaign he was working on was too unpredictable. Julie said he seemed to feel genuinely bad about reneging, but he did not tell her to convey that disappointment to me, and I never heard from him again.

I was astonished at the Canadian's … what? Negligence, cowardice, rudeness? It was a sickening roller-coaster ride: hope yielding to helpless frustration, gratitude giving way to fury. How dare he reduce me to groveling and dependence? Yet I assume he intended no such thing. I think the Canadian was actually quite devoted to the idea of giving a kidney – just not necessarily now or to me. He had led me on for weeks, and would have continued doing so had Julie not pushed him. Meanwhile, my kidneys were deteriorating, and I didn't have time for more cycles of commitment, silence and rejection.

Just before the Canadian withdrew, another potential donor had contacted me. She was the right blood type; even better, she was the right personality type. On March 4, 2006, I became the proud owner of Virginia Postrel's right kidney. She was out of the hospital within three nights; I was home after seven, and our recoveries were uneventful. I require no drugs except medication that prevents my body from rejecting the new organ.

Altruism is a beautiful virtue, but it has fallen painfully short of its goal. We must experiment with offering potential donors other incentives for giving, not necessarily payment but material reward of some kind. Unless we stop thinking of transplantable kidneys as gifts, we will never have enough of them.

Advice: Sally was able to discover her kidney condition through a routine physical exam, which gave her the time to find a good donor. Get a physical exam when your doctor suggests it.

Browse for related stories in the index at the very bottom of this page, or read a kidney transplant story.

Thanks to Sally Satel for the source story in yesterday's New York Times Magazine.