Mr. Right and My Left Kidney

By Joan Saltzman

donating a kidney to a spouse

By the time I reached 45, my friends, family, and I had all but given up on my finding the right guy. I mourned the fact that I would never have a child.

A Film Buff’s Mr. Right
Finally, I decided to put the quest for Mr. Right on the back burner and pursue my first love, movies, at the 1993 Montreal World Film Festival. And there on a street corner I met John Katz, EdD. But it wasn’t as serendipitous as it sounds.

I had gone to the festival with friends who were film teachers and who knew John. He was a film professor in Canada and had been a curator for the Toronto Film Festival. I couldn’t believe my luck. Here was a handsome guy with bewitching blue eyes, a great sense of humor, and an encyclopedic knowledge of movies. It wasn’t all perfect, though. John lived in Toronto while I called Philadelphia home.

donating a kidney to a spouse“Getting to Know You…”
We got to know each other through long phone conversations. We had our first date in New York City a few months after we met. John told me he had a confession to make. I braced myself. I had heard many of these confessions from men, and most of them were deal-breakers.

“I have kidney disease,” John told me.

John wasn’t telling some novice about a health problem. I was a medical malpractice lawyer and knew about diseases, at least the ones my clients had.

“It’s only a matter of time before I need dialysis or a transplant,” John added.

This was puzzling because John looked fine. He had a ruddy complexion and seemed to be in very good shape. When we went out to dinner, however, his disease became more apparent.

A Talented Cook
“I’m on a low-protein diet,” he told me. “Some doctors think that since the kidneys metabolize protein, a low-protein diet might slow the progress of the disease. There’s no guarantee, though.”

He ordered only vegetables. He couldn’t even have tofu since that is chock full of protein. For some people, this kind of diet wouldn’t have been such a chore, but John loved food. He was a talented cook. He could recount in meticulous detail wonderful meals he had had over the years. And John might have been denying himself the Shrimp Lo Mein and King Pao Chicken for no reason because there was no real assurance that abstaining from protein would make any difference.

A Back and Forth Affair

John and I dated for years. I would go to Toronto. John came to Philadelphia. We went on vacations together. I noticed that John was not as energetic as I was when we hiked or went sightseeing. I blamed it at first on the nine-year difference in our ages. More likely the kidney disease was sapping John’s energy.

John’s doctors speculated that he had glomerulonephritis, but it was only speculation. A biopsy that should have confirmed the diagnosis was inconclusive. We only knew that John’s kidney function was steadily declining.

 “I Love You”
Our relationship intensified on a trip to California two years after we met. We had a wonderful time. As with all long-distance relationships, however, we had to part. On the shuttle to Los Angeles International Airport, John leaned over and whispered in my ear, “I love you.”

“What?”

I was surprised. I thought I heard what he said, but women in their late forties don’t hear those three little words every day.

“I love you,” he repeated.

“I love you, too,” I stammered.

Now I had a decision to make. Did I want to hook my star to a very sick man? I didn’t struggle with the question for long. I had at last found my soul mate. We would deal with his illness together. A few months later, John asked me to marry him. I said “yes.”

Laugh Lines and the “No-Protein Diet”
Over the years, I did all the medical research I could on kidney disease in general and glomerulonephritis in particular. I found no promising answers. It looked as if John was right. Eventually, the man I loved would need dialysis or a transplant. I hoped that he would get a cadaver kidney before he needed dialysis. I never considered giving him a kidney. I was all too familiar with what could go wrong in surgery. I had decided to wear my laugh lines with pride.

One day in 1996, I walked into the University of Toronto Bookstore. Right under my nose, The Kidney Patient’s Handbook was displayed. It touted a diet much stricter than the one John had been on for years, what I called the “No-Protein Diet.” The diet allowed almost no protein and was supplemented by amino acids. We decided to see Mackenzie Walser, MD, the physician at Johns Hopkins who was doing research on the diet. John religiously adhered to the No-Protein Diet. He even baked his own protein-free bread. John could eat fruits and vegetables, but no meat. In spite of the diet, John’s creatinine, the test that measures kidney function, continued to rise.

Quick Nuptials
John’s university offered early retirement. He moved to Philadelphia. Our first consideration was medical insurance. Luckily, all John had to do to piggyback on to my insurance was to marry me. We had to be married immediately. We couldn’t take any chances on his being uninsured.

We planned a wedding in only a few hours. This wasn’t the kind of wedding my mother dreamed of, but I had never been a matching napkins, tablecloths, and bridesmaids kind of girl anyhow. We were married in Elkton, Maryland, because that little city was famous for providing quick nuptials. We had a wonderful celebration with eight of our friends at a restaurant overlooking the Chesapeake Bay.

A Spousal Transplant… or Not?
There was no time for a honeymoon. The day after our wedding, we made settlement on our house. Several days later, John had his first appointment with a Philadelphia nephrologist, Robert Grossman, MD, whom we heard raves about. We were not disappointed. He spent more than an hour with John, something my husband wasn’t used to in Canada.

What we didn’t know when we first met Dr. Grossman was that he was one of doctors in the kidney transplant program at the University of Pennsylvania. He examined John, studied his blood test results, and told him he was malnourished and anemic. Dr. Grossman said that, while some of his colleagues believed in a low-protein diet, he was not convinced.

The doctor also mentioned that they were performing successful spousal transplants at Penn. I thought it was audacious to suggest such a thing to a bride of less than a week. To be fair, Dr. Grossman didn’t know we had just been married. Still, no one was going to take a kidney of mine! What if I needed it later? I politely said I didn’t think I wanted to donate my kidney.

“You might change your mind when John gets sicker,” the doctor said.

I doubted I was going to have what an unnecessary operation (unnecessary for me, anyway) no matter how ill John became.

When we left Dr. Grossman’s office, John didn’t have kidney disease or a transplant on his mind. All he was interested in was eating real food. That afternoon, he wolfed down a hamburger and cheesecake like a man who had been marooned for years on a protein-free island.

“I’m Not Giving You a Kidney”
As Dr. Grossman predicted, John did get more ill. He would come home from work and fall asleep. He couldn’t walk long distances, and he became paler. He no longer cooked; he was too tired to stand at the stove. For some families, this wouldn’t be a big deal, but for ours it was a calamity. We traded John’s gourmet cooking for my boring fare.

John was referred to the Transplant Clinic for an evaluation. I tagged along and again told him, “I’m not giving you a kidney.” My mother had always told me that I was too much of a “giver” when I showered my friends with love and presents, and that people would take advantage of me. Well, I might have been a “giver,” but I was drawing the line at my kidney.

The Consultation
We arrived at the clinic and were herded into a small room with the others looking for a place on the transplant list and their families. A warm, kindly nurse named Maral talked to us about the transplant operation and the immunosuppressant drugs. Then she discussed a new type of donor operation they had been performing at Penn for about a year now.

“Here they go again…,” I thought.

Maral said that the new operation, called the “closed procedure,” was much less invasive than the usual open procedure, which required an 8- to 10-inch incision around the torso to extract the kidney. The new operation was done laparoscopically, was minimally invasive, and had fewer complications. Nonetheless, I still wanted to hold on to my kidney.

“You’re a Match”
I decided that I would be tested to see if I was compatible with John. I figured there wasn’t much chance of that, and I could look magnanimous, like a “giver,” without having to do anything. Well, there was more of a chance for compatibility than I thought. My blood type was O positive, the universal donor. John’s was AB positive, the universal receiver. Also, the immunosuppressant drugs had improved so much that fewer of the antigens (there are seven of them) needed to match than ever before.

A few weeks later, Maral called me with what she thought was good news.

“You’re a match,” she declared.

Uh oh…! I went through the necessary tests to ensure that I was healthy enough to donate my kidney to John, hoping that one of them would rule me out. I was told that I could tell one of the doctors or social workers at the Transplant Clinic that I didn’t want to go through with the operation, and they would inform John there was some medical reason why I couldn’t be a donor. I think I forgot I had an out. I wished that there had been a book I could have read, a first-hand account of a spouse who had donated a kidney. But at the time, there was none.

A Change of Mind
John got sicker. His sense of humor was gone. He no longer laughed. And just as Dr. Grossman had predicted, I changed my mind. I decided I was a “giver” after all and that I would give John my kidney. I just couldn’t stand by as John became more and more ill when I knew that, if I gave him my kidney, he would get better.

We had an appointment to discuss our operations with Ali Naji, MD, one of the transplant surgeons. His reputation preceded him. All of the people we met at the clinic sang his praises.

The Laparoscopic Procedure
Dr. Naji was impeccably dressed in a herringbone blazer and dark trousers when we met him. He patiently explained the laparoscopic procedure. Several small incisions would be made in my abdomen so that instruments could be inserted. The ligament holding my left kidney would be cut, my kidney would fall into something that looked like a butterfly net, and would be pulled out through a small incision under my belly button.

I liked the romantic image of the butterfly net. I pictured myself catching monarch butterflies in a field of sunflowers. Dr. Naji said that the left kidney would be taken in the closed procedure because the left kidney is attached by only one ligament while the right is attached by two.

The day of our operations, December 14, 1999, arrived. I had to put my kidney where my mouth was. James Markmann, MD, performed my surgery just the way Dr. Naji had described. I learned later that Dr. Naji personally took John to the operating room and introduced him to other doctors they passed in the hall. Dr. Naji placed my kidney in my husband’s body.

Sydney Joan Kidney
I awoke in the recovery room. There was no sense of time passing before the nurse told me that John had been brought to recovery. She said I would be wheeled past him when I was taken back to my room. As I passed by John, I could see that, for the first time in years, his skin was pink. Could it be that my kidney was already working? I, who had always been sad that I had never given birth, had given new life to someone I loved for years!

We affectionately named my donated organ Sydney Joan Kidney. It is still working in John. He has successfully avoided dialysis and its attendant complications for seven years. He did, however, have bouts with the effects of immunosuppressive drugs, pneumonia, skin cancer, and an accumulation of fluid in the area of the transplant, but all of these conditions were successfully resolved. And my creatinine is still normal. All in all, John and I are healthy and happy, each with one of my kidneys.

“The Best Thing I Have Ever Done”

Giving John my kidney was the best thing I have ever done, hands down. If I had an extra kidney and he needed another one, I would do it again. I would recommend being a living donor to each healthy person whose loved one needs an organ, as long as he or she really wants to donate and is cleared medically.

Being a donor has also made me feel even more strongly that everyone should sign an organ donor card and let their loved ones know of their wishes. It breaks my heart that everyone doesn’t have the chance for a new life as John did because people are “going to their graves” with perfectly good organs.

About the Author
Joan Saltzman is the author of Mr. Right and My Left Kidney, about meeting her husband later in life and giving him her kidney. Mr. Right is available at www.amazon.com, barnesandnoble.com and at your local bookstore. Ms. Saltzman practices law in Philadelphia, PA, and teaches trial skills to large firm lawyers. She is an engaging raconteur and is available for speaking engagements.

01/31/2007

Web ID 362

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