Everyone into the Donor Pool

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Part One

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   “In theory, most of us subscribe to a set of values based on the idea that a human being is an end not a means. You can’t justifiably use a human being as an object. It is wrong to enslave a person, even if that slavery might produce a large good. It is wrong to kill a person for his organs, even if many lives might be saved. And yet we don’t actually live according to that moral imperative. Life is filled with tragic trade-offs. In many different venues, the suffering of the few is justified by those trying to deliver the greatest good for the greatest number…”

David Brooks, New York Times, “The Child in the Basement”

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You Can Too!

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A late September afternoon in 2009 and Oz — the great and powerful Dr. Oz — appears in the Edmond, Oklahoma living room of Ronda Peterson, a 47-year-old school bus driver.

ronda cross1 grey

Oz is on Channel 3, the show just beginning, and Ronda watches as he jump-cuts his way across Manhattan into a studio full of wildly enthusiastic fans and the announcer booms “What they did to save the life of a total stranger! And you can too!”

The audience is on its feet and clapping as Oz bounds onto the set, looks into the camera and promises Ronda a show that she will never forget — and there is more truth in this throw away line than Dr. Mehmet Oz will ever know.

“I’ve got news for you,” Oz tells Ronda. “While you watch this show, someone who is waiting… will die.” And why is that? “It’s because there are over a hundred thousand people on transplant lists today waiting for organs that will never come. When we come back, I’ll tell you how YOU can become an organ donor.”

After the break comes a dramatic video segment explaining how one man’s selfless gift to a stranger initiated the longest kidney donation chain in history, with the result that “eight kidney recipients now have the gift of life.” There are action shots in operating rooms, sweaty surgeons, techs thrusting ominously labeled mini-coolers into the outstretched hands of anxious nurses. The heroic donor, says the announcer, “got the ball rolling by deciding to donate his kidney to a complete stranger. His doctors made this a gift that kept on giving by paring his kidney to a patient who had a relative who made the same selfless promise: to donate one of their kidneys to a complete stranger as well.”

In the final moving scene, a tearful woman, someone’s mother in a hospital bed, looks into the camera and says that without a kidney transplant she “might not make it.” Another commercial break on the way, the announcer promising that if viewers stick around they will meet all the heroic donors and see “How they made this lifesaving choice and how you could too.” After commercials Oz reappears and, in the first of many factual misrepresentations, exclaims that “with me today are ALL the key players” in this amazing, historic transplant chain.

The APPLAUSE sign flashes, the audience again delivers with gusto.

Ronda, home between her morning and afternoon school bus runs, is folding laundry as she watches and is duly drawn in. “Ask yourself this,” commands Oz , “What does it mean to be a hero?” And out comes, stage right, a 56-year-old man with neatly graying hair, navy sport coat, blue oxford shirt and khaki pants. Thomas Koontz from Fredericksburg, Virginia comes across as an exceedingly decent, upper middle class guy with a modest, easygoing manner. He goes by the nickname “Dody,” and he gets away with it because he’s a good guy, a regular guy.

Oz is gushing Hero all over the place as Koontz takes his seat and the applause dies down, but Koontz, a former Marine, shrugs it all off with not a little class as he begins to tell why he felt compelled to give a body part to a stranger. “I don’t consider myself a hero,” he says. “I’m grateful that I could help. I was looking for a way to give something back. I saw people on dialysis and I knew it would be something that would be meaningful and change people’s lives and I’m very grateful and very humbled that I could be a small part of it.”

“God bless you,” says Oz.

A few years back, Koontz’s teenage daughter had been successfully treated for a brain tumor at Johns Hopkins, and the man was so overwhelmed with gratitude that he needed to express it somehow. “When I began this journey, it was all about my daughter,” he tells Oz. “Trying to give back to God, and the surgeons who helped her… So I was in church one morning and there was this lady who needed a kidney,” Koontz says. “It was the first sign from God that, you know, here’s a way you can help.”

Yes, thinks Ronda, who knows something about God, has come through her portion of danger, toil and snares.

But Ronda knows nothing of surgeons.

***

“I found out I wasn’t a match for the lady at church,” says Koontz.

So he strolled into Johns Hopkins one day and told them that he had decided to part with a kidney, would they know of someone who could use it? Koontz smiled as he recalled, if not the actual response, the general tone. “They said ‘Yes Mr. Koontz. We do.’ ”

You don’t have to ask a transplant surgeon a question like that twice — especially a surgeon who wears cowboy boots.

Applause breaks out again in the studio as Oz introduces Dr. Robert Montgomery, sitting in the front row, as the Hopkins surgeon who relieved Koontz of his kidney. Montgomery, according to a Baltimore Sun profile, “shows up at the black-tie surgical fellows’ dinner at the Maryland Club in his black Nehru jacket. Maybe he doesn’t have to worry about tuxedo formalities or the mustache trim. Not anymore, not with six titles to his name at Hopkins… Not with the international speaking engagements, the documentary videographers showing up in his operating rooms on a regular basis.”

“How difficult was this?” Oz asks Montgomery.

“Oh,” says Montgomery, “It was just a logistical tour de force. This took literally months to plan and execute.”

Oz asks his fellow surgeon if he can help everyone understand why these type of kidney donor chains are so important. “Well,” Montgomery says, “there are probably around 2,500 people a year who want to receive a kidney from a loved one, but because of either blood or tissue incompatibilities, they can’t. Swapping kidneys is a way to get those people transplanted.”

Montgomery, himself not averse to misrepresenting facts in the service of a cause, continues: “We are in the midst of a crisis in organ availability in this country,” he says. “The average person has to wait five years for a transplant and about 30% of those patients will die waiting.”

OZ jumps all over this. “Can I underline that? Five years waiting,” he exclaims, holding up a hand to display five digits, “for something that someone else could give you… and a mortality rate of 30%, which means that a third of the folks don’t get there. Which is why I started the show with hammering home the fact that we can save lives now.” Spacing out those last three words for emphasis, Oz gives Ronda and the other two million viewers a look.

According to the Sun, Montgomery is known for his “dramatic flair,” noting that his surgical teams once performed three operations at once. (Which got him into the Guinness Book of World Records.) “That made news, but Montgomery and his surgical teams were just getting warmed up. In the past few years, his teams have performed a series of firsts involving living donor kidneys transplanted into five patients, then six, then the [Oz] production involving four hospitals in four states, 16 patients and new kidneys for eight people.”

A Sun reporter writes that “Hopkins has been doing this for years and the number of kidneys transplanted each time seems to keep rising. At first, it may seem like a publicity stunt, an effort to outdo themselves just for the sake of it. But that is not what goes on here. The more people involved, the more people who benefit from a single kidney donation.”

One of Montgomery’s “firsts” involved removing a woman’s kidney through her vagina. The goal behind that surgery, he says, “was to take advantage of a natural orifice to lessen the physical impact of living organ donation and make the procedure more attractive.” He is excited about the “new frontier of removing kidneys through natural orifices.” Colleagues in medical journals may have dismissed the procedure as a risky gimmick, but making live kidney donation more attractive is what Dr. Robert A. Montgomery is all about — and what this carefully scripted episode of the Dr. Oz show is all about.

What people on the waiting list are waiting for are kidneys from people who just died. While the relatively healthy but suddenly departed are a dependable source of recyclable organs, the annual supply has become finite due to such things as seat belts, airbags and helmet laws. Live donors are said to be the only hope to fill the perceived gap, and they have to be wooed. Montgomery’s appearance on the Oz show is part of a sustained, deliberate effort to gin up publicity for kidney paired donation, which he sees as the best way to expand the donor pool.

***

Sitting next to Montgomery there in the front row of the studio audience is Sage, Dody Koontz’s daughter. Oz asks her what she thinks about her dad’s magnificent benefaction. “Totally in character,” says Sage. “He was so grateful for the gift of life that I had been given, and he just wanted to give that gift of life to other people.”

“So Dody was step one in this historic exchange,” Oz says. “Step two was Kathleen. She’s a mother of two and she received Dody’s kidney…”

And onto the stage comes Kathleen Wolstenholme, a 52 year old blue-eyed blonde from Bucks County, Pennsylvania who radiates something, happiness — or something better — to the national television audience. Her older sister, Theresa, who would soon join her on the set for the big emotional meeting of donors and recipients, says that yes, Kathleen always shined.

Theresa also says that neither she nor her sister were ever told by Johns Hopkins that they were to be part of any historic domino kidney chain. Nor was Kathleen, the program’s showcase recipient of Dody Koontz’s kidney, the “stranger who had a willing but incompatible donor,” portrayed by Drs. Oz and Montgomery. Kathleen Wolstenholme had, in fact, many willing donors and at least one who was compatible: her sister Theresa. When Kathleen was told in April of 2008 that she needed a transplant, Theresa got tested and was told the following May by Johns Hopkins that she was “a good match.”

Theresa would do anything for her little sister, but she had emphatically never made any selfless promise to donate one of her kidneys to a complete stranger. She says that about two weeks before the operation — more than a year after she’d been told she was a good match — she got a call from Kathleen, who told her that Hopkins had found a donor who was “a better match.”

Theresa is not ashamed to admit momentary relief at the thought of not having to undergo major surgery to remove a vital organ. But then Kathleen said that in order to get that “better” kidney, Theresa would have to give up one of her kidneys after all — to a complete stranger.

And by then Theresa felt that she had no choice.

No one thought to ask why it took 15 months to transplant a patient who had more than one willing and compatible donor. No one thought to ask how they could have found a better donor for Kathleen than her sister, or why they didn’t test other relatives who were willing to donate if Theresa’s “good match” wasn’t good enough — which would have been a good question to ask, because, as Robert Montgomery says, “when live kidney donations come from relatives, there’s a better matching of tissue.”

But Theresa Watson, an Administrative Assistant at the University of Maine who had never heard of Dr. Oz, found herself before a national television audience one day hugging and being hugged by a man she had never met — a man who was walking around with one of her kidneys. She was one of the seven donors along with six of the recipients from the Hopkins domino transplant chain who appeared on the show. Most of these people had never met before, and for the segment’s finale, Oz had them all come together on stage. There were hugs all around, prolonged embraces and tears of joy and gratitude. There was much talk of heroism, and God, prayers and miracles.

One pair of people had met before. They were both employees of Johns Hopkins. Robert Imes, the only African-American in the group, worked as a painter in facility maintenance. Pamela Paulk, a vice-president in Human Resources, was on cordial terms with Robert and noticed one day that he was looking poorly. “Robert,” she said, “Is there anything I can do for you?”

“I could use a kidney,” he said.

“I’ll give you mine,” Paulk said.

Just like that.

Paulk didn’t match Robert, so her kidney went to a stranger, and Robert got a kidney from that stranger’s non-matching would-be donor. “It’s been a great experience,” Paulk says.

So the dominoes fell.

Theresa Watson says that despite feeling used and deceived, she is happy that her sister got some good years out of her transplant experience. “When I initially filled out the extensive paperwork, there was a question about whether or not I would be willing to donate to a stranger. My answer was ‘NO’. I only wanted to give my sister my kidney because I loved her. I was not willing to go through all of this to give a stranger my kidney,” she says. “My sister and I were 10 months apart in age, and very close our entire lives. I would have done anything for her. NOT anything for a stranger. So, as wonderful as this chain appears, I had no choice and was never told anything about it until afterwards.”

Theresa and Kathleen found out that they’d become part of transplant history only when their mother called and told them that she’d read it in the newspaper. HIPAA privacy laws be damned, they had become props for the Hopkins PR machine.

On July 7, 2009, Montgomery, in a celebratory press conference to wrap things up, told reporters that “All Johns Hopkins patients are in good condition and are recovering as anticipated.” It made for a very satisfying end to the tale, except that Kathy Wolstenholme was not in good condition and was not recovering as anticipated — unless Montgomery anticipated the massive heart attack she suffered four days after her transplant, despite a supposedly thorough cardiology workup. Two days later, she underwent triple bypass surgery. She was still in the hospital when the press conference took place, and would spend the rest of the month there.

***

Oz wrapped up the segment by telling viewers “We’ve used the word ‘miracle’ a couple of times, but for me the miracle is that of the human spirit.” Turning to the assembled kidney donors, he said “I mean something moved you, who knows why? And each of you had the spirit that makes us who we are. To give forth and just allow life to prosper and go beyond your own body to those next to you. It’s about sharing the most vital resource we all have.”

And then Dr. Oz dispensed some medical advice to further encourage would-be kidney donors in the daytime television audience. “Most folks don’t realize that it’s a very safe thing to do relatively speaking,” he said. “No change in long-term life expectancy, no change in kidney function, you never actually get close to a dialysis unit, you’re just as good as you ever were. I’m going to leave everyone out there with a big call to action. I want all of you watching to know that you can become a living donor…”

It’s all good.

***

Part Two: Ronda’s Miracle