Why the Campaign for Living Kidney Donation is Bullshit: Part Six

Evaluation

 

“It must be ensured that every prospective living donor has to undergo a thorough
medical, psychological and social evaluation prior to kidney donation.”

 

That’s what they tell themselves anyway.

 

What they told Ronda over the phone was to fax back a questionnaire and then go get her blood tested. “A few days before Christmas, Evan and I showed up at the lab for testing. I asked Evan to pray with me before we went to test,” Ronda says. “I prayed that if this is what I am supposed to be doing and this is God’s will for me that ALL tests would come back with no problems—nothing wrong.”

 

A few days after Christmas, the transplant coordinator called Ronda. The tests showed that Ronda’s kidney was compatible with Evan’s body and they could go ahead with the transplant. “I was excited,” Ronda says. “Praise God! I told the coordinator, what a miracle it is that we were a match. A perfect match! Hallelujah!”

“Well… yes,” the coordinator said. “It’s good news all right, shall I call Evan and tell him we can move forward?”

Ronda said yes, absolutely, go ahead and call Evan and tell him about the miracle match.

The transplant coordinator called Evan. She told him that he and Ronda were not a match — far from it, in fact. But they were “compatible.” What she meant was that Evan and Ronda had the same blood type and were therefore compatible insofar as that goes. The doctors could make it work. The transplant center may have been especially eager to make it work, or at least make it happen, because they were barely making the minimum number of transplants needed for Medicare certification.

 

***

The reason Ronda was under the impression that this was such a miraculous development — an impression she advertised to everyone involved — was that she thought Evan had been on the waiting list so long because no one else had ever been a match for him. She thought that’s how it worked. If your kidneys failed, you languished on the waiting list while they urgently kept checking all over the country for a kidney that would match yours. She thought that for years they’d been searching for a match for Evan, that they had been unable to find a match until divine guidance brought Ronda and Evan together.

Dr. E.N. Scott Samara, who would cut out Ronda’s left kidney, knew better. So did everyone else at the transplant center. This was neither match nor miracle. A “perfect match” as envisioned by Ronda would have been a matching of six specific cell properties called human leukocyte antigens (HLA’s), meaning that Evan’s cells would treat the cells from Ronda’s kidney like family so they could all work together toward a restoration of health and vigor. A perfect match between Ronda and Evan would indeed have been miraculous, considering that for starters, the odds of that are about 1 in 100,000. Also, HLA characteristics are hereditary, so it didn’t help that Evan is African-American and Ronda is from pretty much Nordic stock. None of their HLA’s matched — which would have come as no surprise to the medical people involved.

Neither did the transplant staff pay much attention to the miracle business that was obviously on the very spiritual minds of both the donor and the recipient. Asked whether he considered it a red flag that Ronda had decided to donate a kidney to a virtual stranger she met in church on the basis of a television show because God had told her to, Samara said no. “We’re in the bible belt,” he said. We get a lot of that here.

***

The likely reasons that Evan Johnson had been on the waiting list for six years without a nibble until Ronda came along didn’t really have all that much to do with HLA matching, which had all but officially fallen out of favor as a determinant of who’s next. Not that it was a settled matter, but in practice, the view had taken hold among most transplant surgeons that anti-rejection drugs diminished its importance. The Centers for Medicare & Medicaid Services, which pays the bills, still thinks that HLA matching is important enough that they want to know the numbers. Interestingly, St. Anthony reported that there were no 100% mismatches in the period that included Ronda’s donation. They reported instead that they had one case that they were not reporting.

Robert Montgomery takes a firm stance, writing that “there is equipoise in the literature about the effect of HLA matching on outcome.” He also works for Alexion Pharmaceuticals, which manufactures Soliris, literally the most expensive drug on the planet. It’s an anti-rejection drug which comes in handy when, somehow, HLA matching does matter. He used the drug in an off-label experiment on one of the patients in the Oz chain. Montgomery has a great interest in immunosuppression drugs. That’s because the gift of life, which he’s urging everyone else to provide, could more accurately be called the gift of half-life, since according to him, “there is only a 50% chance that the transplanted kidney is going to be working at the end of 8 years.”

That’s certainly not the impression Ronda got from Montgomery on the Oz show. “Save the person’s life… They always say you are saving someone’s life. Which makes the person who does not know any better think that this is a CURE. I sure thought that way,” Ronda says. “I thought once my kidney was transplanted that Evan would live the rest of his life with that one kidney just like I am suppose to live the rest of my life with one kidney. I did not know that even in the best cases all transplanted kidneys eventually fail over time. I did not know if they make it one year that is considered a successful transplant.”

She’s right about that.

“We can do a kidney transplant with a 96% one-year survival rate. I see a lot of 20 year old individuals who need a kidney transplant,” Montgomery says, pointing out that he’s been busy “helping these people get their third or fourth transplants.” These are people who obviously have the resources to navigate the ins and outs of the waiting list. If you really want to know how to game the system, the there’s a slick website called Txmultilisting.com (tx is transplant lingo for transplant). It was created by a recipient named Irena Bucci who appears to know what she’s talking about. It’s the first place I’d go if I needed a transplant and couldn’t talk anyone out of a kidney.

There’s a link on Irena’s site to an article that explains why some people can get on the waiting list merry go round and grab the brass ring three or four times, while other people like Evan never get a chance. Turns out it has a lot to do with money. There actually is no waiting list as the public understands it, where the person who’s been waiting the longest is automatically at the top of the list. For all practical purposes, there are 58 lists, each managed by Organ Procurement Organizations (OPO’s) around the country. These are the outfits that come to the hospital when your relative dies to see if the deceased might be donor material.

When someone with serviceable kidneys dies and permission is obtained, the local OPO notifies transplant centers in their area. Then the transplant centers do an appraisal of both the kidney and potential recipients on their list and try to configure the best outcome, and it’s not entirely about matching or compatibility. There are a lot of issues to consider before they “move forward with the transplant procedure, including whether the patient can afford the post-transplant medical care and immunosuppressive medications,” according to health economics professor Robert Woodward at the University of New Hampshire. Even though Medicare pays to have the actual “gift of life” installed, it only pays 80% of the donor’s immunosuppressant tab — and only for three years. And there are likely to be other required prescription drugs that Medicare will not pay for at all. Many transplant centers will pass over a candidate who does not have secondary insurance.

“Access to kidney transplants is restricted to patients who are unemployed or employed part time, many of whom who may not have insurance due to their employment status,” Woodward says. “Transplant centers have found that patients with limited financial resources have higher rates of noncompliance with post-transplant medical care. Because noncompliance with post-transplant care is a leading cause of rejection, infection, and death, transplant centers may be more hesitant about providing access to transplants to those with limited financial resources,” Woodward says.

As a result of the Medicare reimbursement policy and other factors, more than 20% of recipients stop taking their anti-rejection medicine, and some wind up back on the ever-expanding waiting list. This means that a substantial portion of the entire kidney transplant initiative in this country is pointless; a built-in exercise in futility.

***

In addition to being not wealthy, Evan suffered from diabetes and high blood pressure. But the main reason Evan had probably never been a leading contender in the deceased donor sweepstakes is because he is, as Samara put it, “a big boy.” At 300 pounds, Evan’s Body Mass Index (BMI) was 43, which made him a prime example of someone on the active waiting list who really didn’t belong there. Given the increased risks, according to Dr. Benjamin Philosophe at the University of Maryland Medical Center, “transplant centers normally won’t give an organ to a patient with a body mass index over 40, which is morbidly obese.”

Dorry Segev says this is patently unfair. Patients are suppose to rise to the top of the list with time, not sink to the bottom with weight. But he insists that transplant surgeons don’t really mean to put their own interests above the welfare of patients. He was commenting a study he’d just published saying that transplant surgeons do exactly that. But, he told USA Today, “I don’t think any of this is conscious. It would be hard to imagine any of us in our field would deliberately act against the welfare of our patients.”

A better informed Evan might have opted to remain on dialysis anyway, because, paradoxically, people with his BMI have better outcomes by sticking with dialysis and not undergoing a transplant.

***

They traded faxes and phone calls, but the first time Ronda met with the transplant coordinator in person was during the first week of January 2010, to drop off lab results. “We talked briefly,” Ronda said. “I talked mostly about my excitement about being a miracle match and how God’s hand was in this all.”

The coordinator talked about the need for more tests. “She told me that I needed a TB test done, more blood work, chest x-ray, ECG, an HIV test and a 24 hour creatinine clearance test,” Ronda says. “She said I should save my urine output in a jug that I would be given from the hospital and return it after 24 hours of urine collecting to the hospital lab. She told me that I would need to go to the Oklahoma Health Department for the TB skin test. I did all that I was asked to do.”

Next was the appointment with El-Amm, Ronda’s “Advocate Doctor.”

“So,” Ronda asked the doc, “will I be OK with just one kidney?”

 

“Sure,” said the man with two kidneys, Dr. Jose-Marie El-Amm. He was doing Ronda’s pre-donation evaluation.

It would seem to be a common sense question from Ronda, sitting in El-Amm’s exam room in her paper gown. But Robert Montgomery — who also retains a full complement of renal organs — says it’s just that sort of ignorance on our part that keeps him from breaking even more records. He told CNN that people “realize that hey, I’ve got two kidneys, and really my body will function perfectly well with one kidney.”

 

The mantra “You Only Need One” has been repeated so often that it is accepted as fact. Kevin Sack, who covers such things for the The New York Times, reported that “It is considered a quirk of evolution that humans have two kidneys when they need only one to filter waste and remove excess fluid from the body,” which is news of a sort that physiologists would not find fit to print.

 

Ronda’s doctors told her the same thing that kidney transplant surgeons tell everyone with the courage and generosity to undergo a major surgical procedure for someone else’s benefit. They lie. They told her that there will be little or no loss of kidney function because her other kidney will “grow” and take up the slack. All the reassurance from duel-kidneyed transplant surgeons in medical journals boils down to an assertion that the newly enlarged remaining kidney appears to hold up really well in the long run, which is more wishful thinking than science. In the short run, you don’t have be a medical school graduate to do the math: If Johnny has two kidneys filtering his blood, and he gives one kidney away…

 

“Donor nephrectomy represents the sudden loss of approximately 50% of nephron mass with an immediate and corresponding decrease in GFR…” is the stark and obvious answer. Nephrons are the tiny tubes in the kidney that filter blood and produce urine, and GFR is how kidney output is measured. With the remaining kidney suddenly engorged with a doubling of blood volume, it does indeed “grow.” It is stretched to its limits. It’s called hyperfiltration, which, in the general medical realm of urologists and kidney physicians, is seen as an unhealthy development. In transplant lingo, however, the term is “benign hyperfiltration.” If you peruse enough kidney literature, you’ll come across a common opinion regarding hyperfiltration, benign or not: “One main problem with the diagnosis of hyperfiltration is that no generally accepted definition is available.” They don’t even really know what it means, but apparently, if you lose kidney function by choice instead of chance, it’s a good thing.

 

In any event, the remaining kidney does get bigger as it compensates for the loss of its counterpart, but having about a gallon and a half of blood suddenly pumping through one kidney 20 times an hour takes its toll. There is immediate damage to the kidney itself, and over time, the back pressure is hard on the heart. The results can include inflammation, ventricular enlargement and aortic stiffness, blood clots, anemia and other damage to the circulatory system. Even a small reduction in kidney function significantly increases the risk of illness and death from cardiovascular disease and on average, living kidney donors experience a 30% permanent loss of kidney function.

 

The elephant in the operating room is that donating a kidney translates for many people into de facto Stage 3 Chronic Kidney Disease. Transplant surgeons insist that Stage 3 CKD from donating a kidney is somehow not a bad thing in and of itself. Not like regular Stage 3 CKD that people come by honestly through the usual means: diabetes, high blood pressure and heart disease — all of which are risks of kidney donation.

 

In an editorial for a nephrology journal, Dr. Jürg Steiger at the University of Basil notes that surgeons promote transplantation because it is “the treatment of choice” for kidney failure, and that “given the lack of cadaveric donors, it is not astonishing that a certain pressure arose to recruit living donors.” Steiger is one of the few who takes the next step in logic: It may be the best way to go for the recipient, but is “kidney donation really safe for the donor?” He points out all the well-known flaws in the studies that assert live donation carries little risk, and asks “Why did mother nature provide us with two kidneys? Renal function is crucial and therefore nature supplied us with a reserve in case of kidney disease or if we damage one kidney. Fortunately, most of us do not need this reserve. It seems that nature gave us too much kidney mass for one lifetime—at least to the selected donors reported in the literature!”

 

In addition to removing wastes from the blood, kidneys also help regulate blood pressure, balance electrolytes and other body chemicals, produce red blood cells and Vitamin D, metabolize Vitamin A, and aid in processing of glucose and amino acids. Any honest physician will tell you that the kidneys probably perform other functions about which they know nothing.

 

In a response to Steiger’s letter, a group of pediatric kidney doctors report on the consequences of starting out with one kidney. “Being born with a solitary functioning kidney induces a very real health risk starting already during childhood, quite different from being born with two kidneys. Being born with two kidneys is therefore highly desirable, which may be the reason why mother nature did provide us with two.”

 

***

Ronda trusted Dr. El-Amm for the same reason she trusted God — she thought his job was to look out for her. That’s what they told her. It was January 12, and Ronda was there in his examination room under the impression that El-Amm was her “Advocate Doctor.” Actually, El-Amm is the medical director of the INTEGRIS Nazih Zuhdi Transplant Institute in Oklahoma City. His interests include kidney transplantation in high risk recipients — like Evan. “All I do is pre-transplant clearance of potential donors for kidney transplant patients,” he later said. “Basically I made sure that she was suitable for surgery. I’m not an independent donor advocate. An independent donor advocate is a completely different person than I’m supposed to be.”

His job was to see if this thing would work, to see if Ronda was a person from whom they could extract a usable kidney.

El-Amm’s evaluation, which took took about 25 minutes on January 12, was the first time Ronda met with a doctor concerning her donation. Theoretically, the doctor who does the evaluation would have no connection with the transplant surgeon. It might not be ethical. During Ronda’s assessment, there was a soft knock on the exam room door, and Dr. E.N. Scott Samara stuck his head in. Samara, who has privileges across town at St. Anthony where he would operate on Ronda, is the director of surgery at INTEGRIS Nazih Zuhdi Transplant Institute in Oklahoma City.

Evan Johnson was one of his patients.

Samara is also Dr. El-Amm’s boss, and had some matter to discuss with him. Upon seeing Ronda and learning who she was, Samara tossed off some banality about how pretty Ronda was, and went on his way. El-Amm proceeded with his appraisal of Ronda’s fitness to withstand unilateral laparoscopic nephrectomy. But first he asked Ronda if she realized that she was giving her kidney to a man who was much larger that she was. Well, yes, of course Ronda was cognizant of the fact that Evan Johnson had more than a few pounds on her — almost twice as many, in fact. But she didn’t immediately grasp the implication in the question. El-Amm jotted down some notes. He reassured Ronda, based on Ibrahim’s bullshit study, that kidney donors live long, healthy and richly rewarding lives.

“I was told that many people are born with only one kidney and never know that they have only one until for some reason they have a medical test that shows this information,” Ronda says. “I was told that living kidney donors have no greater chance of developing kidney disease than the general population with two kidneys.”

She was also told that some donors develop a slight rise in blood pressure, but medication can control this and it’s usually is not a problem. She was told that some donors have problems with getting life insurance or keeping their health insurance after donation and that she needed check into how donating could affect those things. She was told that if she gained back the weight she’d lost recently, it would be hard on her remaining kidney.

As far as Ronda was concerned, those were the highlights of her first interaction with a doctor on the transplant team. So far, so good.

Ronda’s medical history as of January 12, 2010 included obesity with a cycle of weight loss and gain, depression and hypothyroidism. She had a strong family history of heart disease and diabetes. She had lost 50 pounds over the past several months using one of those unsustainable snake oil diets that cause unsafe, drastic weight loss. It’s called the HCG diet and, coincidentally, Oz plugged it in 2013 just before he was hauled before Congress for being a snake oil diet salesman.
At her initial consultation for the transplant operation, the HCG diet had Ronda weighing in at 182 pounds. She was 5’5″, giving her a body mass index of 30 — the cutoff for overweight donors. There is evidence to show that, just as Evan Jackson’s weight should have precluded him from being a recipient, Ronda’s weight should have precluded her from being a donor. “Our analysis showed there is a risk of kidney damage for those people who are just overweight and not obese,” reported Dr. Kalyani Murthy at Tufts University School of Medicine. “Transplant centers need to be aware of this when counseling potential donors.”
Dr. El-Amm did warn Ronda against regaining weight after donation, but if he were really Ronda’s “Advocate Doctor,” he would have — or should have — advised her against donating in the first place.

What El-Amm jotted down in notes later forwarded to Samara’s office was that if Ronda did regain the weight she lost on her yo-yo diet, she would “clearly be at risk for diabetes” and kidney disease. He wrote that she had recently quit smoking and had the beginnings of emphysema, but that her lung exam was “pretty normal.” He suggested that as an altruistic donor, she should have a psychological examination. He noted that she needed to see the social worker and the donor advocate at St. Anthony.

Evaluation complete.

Ronda Peterson would do.

 

***

Consent

 

On January 18th, Ronda went to the transplant center to meet, she was told, with a social worker and then a counselor for psychological testing.

Here are the guidelines for a psychosocial evaluation of someone who wants to be an organ donor: (Feel free to skip over it, everyone does. It is posted here to contrast with reality.)

LIVING DONOR PSYCHOSOCIAL EVALUATION

Goals of the psychosocial evaluation:

To identify and appraise any potential risks for poor psychosocial outcome, including risks related to the individuals psychiatric history or social stability.

To ensure that the prospective donor comprehends the risks, benefits and potential outcome of the donation for herself or himself and the recipient, and that the donor understands that the data on long-term donor psychosocial outcomes continue to be sparse.

To assess the donor’s capacity to make the decision to donate and ability to cope with the major surgery and related stress.

To assess donor motives and the degree to which the donation decision is made free of guilt, undue pressure, enticements or impulsive responses.

To review lifestyle circumstances (e.g., employment, family relationships) that might be affected by donation.

To determine that support systems are in place and ensure a realistic plan for donation and recovery, with adequate social, emotional and financial support and resources.

To identify any factors that warrant educational or therapeutic intervention before donation can proceed. The team needs to identify the donors anxiety, depression and mental conditions as well as any unsafe reasons for wanting to donate.

Key personnel for the psychosocial evaluation.

A licensed social worker, psychologist and/or psychiatrist familiar with the transplant process should perform the psychosocial evaluation of the living donor candidate. Whenever possible the person conducting the evaluation should be independent of the transplant program.

The evaluator should have at a minimum a master’s level education. The evaluation should include an assessment of donor’s understanding of the entire donation process. The evaluation should also include an assessment of the donor’s anxiety and depression levels and the donor’s ability to cope with stress and a possible poor outcome.

Members of the donor team should have access to the living donor assessment, yet the assessment should not be included in the recipients chart. It is necessary to exclude this report from the recipient’s records because the donor is doing this voluntarily and for no personal medical benefit.

The prospective donor must be advised that the information contained in the report will be subject to the same regulations as regular medical records and cannot be additionally protected.

In order to protect the donor as much as possible the more sensitive questions should be at the end of the psychosocial evaluation. Therefore, if the evaluator determines earlier in the evaluation that the individual is not an appropriate candidate, the more sensitive questions will not be asked and the answers will not appear in the report. Include the following components to complete the psychosocial evaluation:

History and current status: Obtain standard background information such as the prospective donor’s educational level, living situation, cultural background, religious beliefs and practices, significant relationships, family psychosocial history, employment, lifestyle, community activities, legal offense history and citizenship.

Psychological status: Establish the presence or absence of current and prior psychiatric disorder, including but not limited to mood, anxiety, substance use and personality disorders.

Review current or prior therapeutic interventions (counseling, medications); physical, psychological or sexual abuse; current stressors (e.g. relationships, home, work); recent losses; and chronic pain management. Assess repertoire of coping skills to manage previous life or health-related stressors.

Relationship with the transplant candidate: Review the nature and degree of closeness (if any) to the recipient, (i.e.. how the relationship developed); and whether the transplant would impose expectations or perceived obligations on the part of either the donor or the recipient.

Motivation: Explore the rationale and reasoning for volunteering to donate, i.e. the ‘voluntariness’, including whether donation would be consistent with past behaviors, apparent values, beliefs, moral obligations or lifestyle. Determine whether it would be free of coercion, inducements, ambivalence, impulsivity or ulterior motives (e.g. to atone or gain approval, to stabilize self-image, or to remedy a psychological malady).

Donor knowledge, understanding and preparation: Explore the prospective donor’s awareness of the following: any potential short and long-term risks for surgical complications and health outcomes, both for the donor and the transplant candidate; recovery and recuperation time, availability of alternative treatments for the transplant candidate, financial ramifications (including possible insurance risk).

Make sure that the donor understands that data on long-term donor health and psychosocial outcomes continue to be sparse. Assess the prospective donor’s understanding, acceptance and respect for the specific donor protocol, e.g. willingness to accept potential lack of communication from the recipient and the donor’s willingness to undergo future donor follow-up.

Social support: Evaluate support networks available to the prospective donor on an ongoing basis as well as during the donor’s recovery from surgery. Consider significant others, family members, social contacts and employers.

Financial suitability: Determine whether the prospective donor is financially stable and free of financial hardship; has resources available to cover financial obligations for expected and unexpected donation-related expenses; is able to take time away from work or established role, including unplanned extended recovery time; and has disability and health insurance.

***

The Team

“Use of an independent donor advocacy team that focuses on the donor’s needs is of paramount importance. Such a team can best protect the donor if it offers the multidisciplinary expertise needed to address the whole range of medical, ethical, social, and psychological questions and issues. Each team should include a clinician with experience in transplantation, a social worker or other mental health professional with experience in interpreting donor motivations and addressing intrafamilial conflict, and a nurse. Whether these healthcare professionals or another group of healthcare professionals are involved, the goal is to provide the expertise and skills necessary to ensure (1) that the potential donor adequately understands the risks that surround his or her donation and recognizes the uncertainties involved, especially in the absence of comprehensive data about outcomes…”

At 10 am, Ronda arrived at the social worker’s office for the first part of her psychosocial evaluation.

The woman introduced herself by name, not by title. She asked Ronda some questions and took notes — 20 handwritten lines on a notepad. At the top of the page the woman had written Independent Donor Advocate, and she drew a box around it several times, as if doodling during the interview. She wrote that Ronda was interested in donating to an acquaintance she’d met at church whom she had known for about six months. She noted that Ronda had decided to become a donor after watching Dr. Oz on television, and that they discussed that Ronda would have to get some time off of work and that she might have issues with life and health insurance. She wrote that Ronda told her she’d already seen her Doctor Advocate. She wrote that Ronda “appears to be an excellent informed donor.”

Then she gave Ronda her business card, and bid Ronda farewell.

The next office was right down the hall. Here a woman took out a form with “Living Related Donor Psychosocial Assessment” printed at the top and a number of blanks to be filled in below. There was a section for personal information, which noted Ronda’s affiliation with the non-denominational People’s Church; that her hobbies included writing poetry, and that she enjoyed being with her dad and they had fun going to demolition derbies when he was alive. There were check boxes for military service and veteran’s benefits; “No” to both. Health History included thyroid problems and depression. As for the proposed organ donation, it was noted that she had family support. There was a column for Strengths, the singular element being that Ronda had some sick leave available. Under Negatives was written that she did not have a close relationship with the recipient.

Problems: “None.”

Summary: “Potential donor is a good candidate. Understands all info. No concerns at this time.”

It was 10:30 am.

Thus concluded the social and psychological evaluation of Ronda Peterson’s fitness to become an organ donor.

***

The next day, January 19, Ronda met with surgeon E.N. Scott Samara

Ronda told Dr. Samara about what her Advocate Doctor said about giving her kidney to a much larger man. She said it was bothering her. Why would he say that? Does that mean my kidney will be wasted?

“Your kidney will not be wasted,” said Samara.

“He talked about the incision and how he would do it unless I had a complication and he needed to open me wide open to save my life,” Ronda says. “He said there are very small risks with anesthesia. There were risks with any surgery, including death. He examined me. We talked about the HCG diet that I had been doing to lose weight. I talked about what a miracle it is that I am a match and I am ready to do God’s will for my life. We agreed that I would proceed and I would set up a transplant date with the coordinator. He also told me that what I was doing is a good thing.”

Chief Complaint: Healthy living donor.

History of Present Illness: “Patient is a 47 year old female who is otherwise healthy. She wishes to donate a kidney to a very good friend…”

Plan: “All the risks, benefits and alternatives to kidney donation were explained to the patient in detail. Plan for left laparoscopic nephrectomy on February 15. She wishes to proceed at this time.”

This concluded all the preliminaries to Ronda Peterson’s surgery. The transplant team considered her to be fully informed about all the implications, risks and benefits of undergoing surgery to remove one of her kidneys.

***

The next day, with the procedure still three weeks away, Evan Johnson was taken off the waiting list for a deceased donor kidney.

Ronda prayed and prayed that she was doing the right thing, that giving one of her kidneys to Evan was God’s will. Still, just to be sure, she called the transplant coordinator and asked if was possible that whatever ruined Evan’s kidneys would ruin the on she was giving him.

“No,” the coordinator said. “He wouldn’t even be allowed on the waiting list if it was like that.”

***

On the morning of February 15, 2010, 96 days after she called the transplant center, Dr. E.N Scott Samara picked up a scalpel and proceeded to remove Ronda Peterson’s left kidney.

She had met with four people, including her surgeon, for a total of about 90 minutes before the operation. She had no real grasp of what she was doing, except following an impulse to do a good thing, to be an instrument of God’s healing

Pix Ronda conked out in hospital bed

 

###

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