HIOn the morning of September 13, 2017, Martha Myers was being prepared for surgery at the Royal Free hospital in north London. Stayin ’Alive is playing in the background. The anesthetist asked what he wanted to hear, and he asked the Bee Gees – the "happy music" that brought him back to his youth in Colombia. Meanwhile, 130 miles north, at Nottingham City Hospital, Ryan Mace wrestles with a pair of green surgical stockings, worried that his dress will reveal his buttocks when he walks to the theater. He wanted to do something like this since he was a teenager and now at that time here, he was ready. Returning to London, south of the river at St George's hospital, Steve Abbott woke up feeling anxious. But he is a good ward for life, full of vibrant football talk that makes his mind loose from the day ahead. When the time for surgery finally arrived, he squeezed his son Ben's hand before being taken away.
Martha, Ryan, and Steve are perfectly healthy. But during the morning, surgeons in three hospitals struggled with fat tissue and cut blood vessels to remove the kidneys from each hospital. The organs are packed in ice and taken to the corridor, then handed over to couriers who want to go up the road.
Later that day, the theater staff returned to work. Martha's kidney arrived in Nottingham, where it was transplanted to Ryan's best friend, Lee Bennett. Kidney Ryan goes to M1 to south London, and is given to Steve's son, Ben. And Steve's kidney made a short trip across the Thames to sew into Martha's husband, David. The circle is complete.
This is a strange magic kidney donation chain. If you need a transplant in the UK, you can join 5,000 other people on the national waiting list for kidneys from deceased donors. Or, if you are lucky, your partner, sibling or friend might offer you as a living donor (for many people, as long as they have been fully assessed, it is possible to live healthy with only one kidney). But if you and they are not in accordance with blood type or type of tissue, transplantation may not be possible.
Instead, you and your potential donors can join the UK Living Kidney Sharing Scheme (pdf). Four times a year, in what is known as the matching process, sophisticated algorithms work chains that connect incompatible couples like Martha and David, Ryan and Lee, and Steve and Ben. Strung back into a suitable partner, everyone in the chain who needs one end finally gets a kidney – not from a friend or loved one, but from a stranger.
This process depends on the mastery of logistics by staff in 23 transplant centers in the UK, as well as confusing computer science built around. Ideally, all operations in the chain are scheduled to take place on the same day, within eight weeks of the matching process, and only after everyone has carefully assessed to make sure the match will work and they are healthy enough for the operation.
This scheme is very unknown, among the general public at least, but the impact continues to increase every year. The first British kidney exchange occurred in 2007, with a two-way exchange between four people. In 2017/18, 127 of the 1,010 kidney transplants performed – one in eight – emerged as a result of the sharing scheme. This is also a British success story: Britain is far more than any other country in Europe in this field, carrying out about half of all transplants made possible by sharing schemes.
JAfter more than a year after their surgery, five of the six members of one chain agreed to meet to talk about their experiences and be photographed for the Guardian. (Sixth, Steve, living in the US and joining us through FaceTime; then he will be digitally added to the magazine group image.) Even though some patients and donors fit in the chain, eventually exchanging cards or letters after the transplant is complete, only a small percentage met: anonymity is an important part of the process.
"A good group of handsome people!" Martha said when she and David entered the photo studio, where Lee and Ryan were waiting with their partner. As the author who regulates this, I have been worried about the meeting, for fear that it might be strange. But when I introduced 43-year-old Lee to Martha, 60, as the man who got his kidney, he held his hand, pulled it into a hug and began to cry softly. "Nice to meet you," he said, a big smile on his face. "I take care of it for you." They talked. Had he ever been on dialysis, Martha asked: he supported her husband almost nine years before his first transplant in 1999; when the kidney begins to fail, he is determined to donate it himself, rather than seeing him get sick again. No, Lee said, but he was on the brink: "You came to beat the clock on time."
Ben slipped into the room 10 minutes later, all but unwittingly as a group exchanging recovery stories and praise for the NHS. He and Ryan, their donors, greeted each other with warm cheerfulness, close handshakes and exchanges, "Alright?"
There is convenience in the room. David, 70, is an amateur expert on all kidney related matters and was quickly appointed as an unofficial old statesman from the group, while Ben, 27, was friendly, dry and dizzy. Their conversation reveals a shared understanding of the poor health and joy that successful treatment can provide.
"With my first transplant," David announced to the group, minutes after arriving, "I knew it was from a woman because as soon as I started urinating I sat on the toilet." They talked about what they all remembered about the day of surgery: one donor had misunderstood the instructions to only drink clear liquid and enjoy a cup of tea with milk in the morning, causing a terrible last minute delay. "I'm really far from the operating table," Ryan remembered. "All I can think of is Lee."
The culprit, immediately revealed, is Martha, who with irresistible victory does she hold to the need for greater good in the world or sniff tears. "I love him," said Lee's wife, Karen at one time. "I want to take it home."
Far from the frenzy of tea that was made and the photographer set his sights, Lee and Ryan sat side by side, legs crossed above their knees. They have known each other for five years, but consider themselves best friends. Both grew up in villages near Nottingham, and later learned that they had played rugby against each other at school. "We have the same silly sense of humor, the same interests. We just hit him, "Ryan, 42, said. "He is a person who is so relaxed – I have learned a lot from him."
But when they know each other, Lee, who runs the kitchen design business, is getting sicker. At the age of 28, soon after returning from his honeymoon, he found he had a polycystic kidney, a condition inherited that his mother, who died when he was 18 years old from a brain tumor, had suffered too. Karen would give her a kidney if she could, but already knew she only had one good one. Ryan, who worked for the Royal Air Force in recruitment and selection, quickly stepped inside. "For me, there is no brain," he said. "Experts say that I will be fine, so why don't I try to help someone? Seeing how Lee's health deteriorated, there was never a question in my mind. "
He cried after seeing Lee for the first time after surgery. "It's just a relief, I think," he said. "The big thing for me is his eyes. Because we are getting closer to the operation date, they are quite dark and concave. When I see it afterwards, it's like a different man. "He has stored green surgical socks; see them make him smile. Lee still found it difficult to understand that a friend would do what Ryan did. "This makes me go back to the twenties again," he said. "It feels like a miracle drug."
TThe main business of the kidneys is to remove toxins and excess fluid from the blood and turn dirt into urine; when not, they remain in the body, causing symptoms including high blood pressure, extreme fatigue and persistent headaches. If left untreated, kidney failure is ultimately fatal. In addition to transplants, dialysis – which filters the blood using either the machine or the inner lining of the stomach – is the main treatment; but only partially compensates for kidney function that is lost, interferes with daily life and can cause unpleasant side effects. Transplants save and change lives.
"Kidney disease and dialysis affect everything we will receive in life," explained Lisa Burnapp, NHS Blood and Transplant's main nurse for living donations. "They can have an impact on your work, your ability to have children, what you can eat and drink, where you go on vacation." And while the average wait for a kidney from a deceased donor has fallen to more than two years, kidney life is preferred – because it comes from a healthy person and can be transplanted in a planned manner. That is often described as a Rolls-Royce transplant.
I joined Burnapp at Guy's hospital in London on a sunny morning earlier this year, when he saw the results of the matching process carried out the day before. This algorithm, developed by Glasgow University's computational science school, identifies several different types of exchanges. There are circular exchanges between two or three pairs, but also chains that are started by altruistic donors – people who just want to donate kidneys to anyone who needs them, not to someone close to them. This is a gamechanger, Burnapp told me, because one of them can activate up to three transplants, with one kidney ending with the patient on the main waiting list.
Altruistic donors on the list used are given the opportunity to choose the right path. But starting this year, in an effort to increase the number of transplants, they have been added automatically – unless there are high-priority, difficult-to-match patients on the waiting list for who they are "gold tickets".
We peeked at the Burnapp laptop: the matching run was triggered at 10.39 plus 10 seconds. One hour, 32 minutes, and 32 seconds later, the algorithm has filtered 271 patients and their partners to identify 82 transplants, including 17 three-way exchanges. This is the highest number of transplants that have not been identified in one run. Fun, said Burnapp, and evidence that efforts to develop the scheme were successful. "For me it really lifts my heart, because this is a patient who will never see a transplant. That just means everything, really. "
Since the living kidney scheme began in 2007, around 2,000 patients have been registered there, and more than 900 people have benefited from transplants – including 19 children, the youngest three years old.
As well as meeting chains that have undergone surgery, I want to talk to a pair that is undergoing the process. I met Richard and Maureen Ventre at the Royal Liverpool hospital with their donor coordinator, Ann Strong, 12 days before Maureen would give a kidney which meant Richard had a much-needed transplant. As a retired managing director of the family construction business, he was diagnosed with kidney failure in 2016. It was surprising: unlike many kidney diseases, the problem appeared quickly. "It's like you have a good battery and you suddenly just disappear," he said.
He and Maureen met in the heat wave of 1976, working in the summer at a magnificent hotel in Georgia in Torquay. He was a 23-year-old student from Liverpool and he, aged 17, came all the way from Glasgow. Scousers, geords and Glaswegians always seemed to be attracted to each other, they remembered, and one night they found themselves on a double date. Today, they have the calm and calm closeness of a couple who has been married for almost four decades.
Six years ago Ventres lost the oldest child of their four children, Tim; he sank in a swimming pool in El Salvador at the age of 30. He was a traveler, Richard explained, and they would love to follow in his footsteps; Southeast Asia, maybe, isolated. They are not sure it will be possible now, but they still remember it.
Maureen, who worked until recently at reception at a local college, had clear and fussy eyes, but when I asked about her decision to donate, her face wrinkled with tears and no words came out. "That's obvious," he finally muttered. "No, it's not difficult."
In fact, he and Richard, 59 and 65 respectively, were suitable, so that his kidney could go directly to him; but they decided to use a sharing scheme in hopes of making it more suitable. This is encouraged: the more couples in the pool, the more transplants. They are now in an old altruistic (and anonymous) donor chain: Richard's new kidney will come from an altruistic donor and Maureen will go to the patient with another partner, whose donor kidney will go to someone on the waiting list.
At 8 am at the point on the morning of their surgery, Strong got a call on his cellphone from the kidney hospital Richard came from; everything looks good there. He checked with the center that would accept Maureen's kidney; also good to go.
I joined him in the theater later. The kidneys must be cut and dried from the yellow fat surrounding it until only the veins, arteries and ureters hold it; Continuous friction from the cutting tool rings in a cold room. Keyhole surgery is done through three 1cm incisions, the surgeon, Ajay Sharma, holds the instrument while the registrar holds the camera (the kidney will come out of a larger piece, about 7cm long). They stood almost shoulder to shoulder, never looking away from the big screen above them, pink from the kidneys and the fat seen in their glasses.
Dan Ridgway, the second surgeon, looked from the sidelines. "These are people who keep me awake at night because, basically, you are a healthy person who has operations that you don't need," he said. "I don't even call them patients. They are VIPs. "In the afternoon, he will be the one to improve Richard Ventre's new kidney in his place.
Once the arteries are clamped and cut, it is very important for the health of the kidneys to be removed as soon as possible. The time after each is recorded on the board. "Time on the board, arterial one," Ridgway said. "12.06," came instructions from Strong to the nurse. At 12.09, they repeated the process for the second artery. Veins were cut last, and suddenly, at 12.10, a bowl of kidneys was pushed toward Ridgway. His job now is to cool it quickly and draw out blood. A tall man, he sat bent on a trolley at the foot of the operating table, placed the kidney on a sterile ice sheet and used tweezers to look for arteries. The hanging beside it is a bag of perfusing fluid – the liquid used to wash the kidneys – and once he has an artery between his thumb and forefinger, the registrar inserts the tube. The liquid flows in and the water in the bowl turns red gradually as the blood flows out. The kidney becomes pale. "It's nice to see it live when they graft it," Strong said, "because the color entered and then it turned pink."
Ridgway carefully peeled away the remaining fat and cut it with long, curved scissors. "The kidneys are quite large," he said, giving him a little pressure.
This organ is bagged threefold, floating in diluent liquid, and Strong buries it in an ice box. Ridgway got a text from a surgeon who had removed the kidney that would be Richard Ventre. "Everything is fine," he said. "Good luck."
Under the fluorescent corridor, the courier was waiting for us and, as soon as the file was filled, he was not in place, returned to the elevator and headed for the hospital where the next patient in the chain was waiting. This is 12.31 noon. You can get enough kidneys anywhere in the UK in four hours, said Strong. Couriers often use blue lights, and organs are flown between cities for longer trips. "Every hour," he said. "The longer it gets out of the body, the slower it is to work."
Right after 4:30 p.m., Ridgway – who visited Anfield to buy Liverpool equipment for his son during an operation break – appeared his head to Strong's office: the donated kidney had arrived. We took it from the ward and Strong gave it a cheerful box, "It's yours." He jumped into the elevator, headed straight for the theater. In the office, Strong leaned back in the chair and beam. "Here it is," he said. "This is amazing, isn't it?"
WWhen we met, David told me he didn't want his wife to donate a kidney. "I just don't want him to pass it," he said. "But he made me realize that I had to do it – not only for myself, but for him." They gathered six months after Martha arrived in England from the Colombian city of Bucaramanga to study business in 1985, and married five years later. "In the next three months, he will fall ill and have the best years of our lives because having a family has been lost," he said. In his final year in dialysis, David was so weak that he was forced to close his successful design and consulting art, which was only 49 years old. "What kind of life is it for both of us?" Martha asked about her prospects. husband returned to dialysis. "I don't think that I can handle more," he said.
When he got up from surgery last year, David did not believe how good he felt. "I send SMS, email," he said. "I feel great." He listened to music on many radios in the following days and often found himself crying, flooded with what realization Martha had, and the scheme of kidney exchanges, was possible.
"Some people say, & # 39; you're not lucky because you've been sick for so long & # 39;" he said. "I was lucky. I was lucky Martha came into my life and I was very lucky because I got this kidney. I had the opportunity for us to go and enjoy ourselves."
This is Ben's second transplant, too; he suffered kidney failure at the age of 19 and his mother donated directly to him three months later. Beginning in 2016, the recruitment consultant was told by his doctor at the St Helier hospital in Surrey that the kidney might only last another six months. He admitted he didn't mind the two months he spent on dialysis before his first transplant ("I had to watch Come Dine With Me for four hours three times a week and eat really good sandwiches") but this time, with a partner, demanding work and a football team a ball full of teenagers to train, he was desperate to avoid it.
"When we are together, we are like two peas," Ben said of his father. The night before the operation they went to the pub to watch their favorite Chelsea football club defeat Qarabağ FK 6-0 Azerbaijan ("He has a glass, I don't"). A few months before, they would be part of another chain, but the operation was canceled the day before because one of the recipients was unwell. (To run I saw with Burnapp, 57 of 82 transplants discovered by the algorithm – 70% – finally happened; the numbers increased and the completion target was 75% by 2020.)
The delay was difficult, but Ben was told that Ryan's kidney – "the big watery one" – was actually a better partner for him. "This works wonderfully," he said. Of all the people in the chain, he was at least given to stay on the emotional side of what he experienced, even though he remembered crying at his first dialysis session, struck by the reality of how painful he was.
I talked to Ben's father, Steve, on the phone. Even though he lives abroad and eventually travels back and forth to England seven times a year as a result, he is determined to donate. "She's my child," said the 55-year-old builder. "It's simple like that. You don't like to see your children suffer."
Steve hopes his kidneys will give someone a good life but never really think about who will end up with it. "As long as Ben gets his kidney and he's fine, you can put it in the pie and cook it, for everything I care about," he said. But when Ben caught him in the video call at the photo shoot and David told him how grateful he was, something shifted. "When I started talking to David, it sank a little," he told me later. "It was done for Ben, but I have helped others have a normal life."
David, meanwhile, was very happy to learn that his kidneys were from fellow Chelsea fans. He e-mailed Steve that night, and then shared the message with me: "It is a wonderful feeling to think that someone like you has made this extraordinary gift for your loved ones and you end up not only helping one but two people," he said. . "One million thanks to you."
A few months after their surgery, I followed Ventres. Richard's kidneys worked well and he started playing golf again. Maureen still feels lethargic in time, but she enjoys walking and swimming, and hopes to return to yoga soon. They will spend their 39th wedding anniversary at the hotel in Torquay where they met, their first trip back since the 70s. And they still hope to travel to some distant destination, if the doctors agree.
Meanwhile, members of our six strong chain plans to stay in touch. Ryan and Ben have been chatting online about their recruitment work; David and Martha want to take Ben and his father to the Chelsea match, the next time Steve is in England, maybe even get a box. Martha and Lee met for a drink when he was next in London, and he hoped to arrange a reunion for everyone a year from now.
When they met, Lee told the group that he thought he was only interested in meeting Martha, his donor. "But after meeting everyone it was strange how it all seemed to be interrelated," he said. "Nothing will happen if it's not for everyone."
• For more information, go to organdonation.nhs.uk/about-donation/living-donation Hear Rachel Williams talking about the story behind this article about the new Guardian podcast, Today in Focus, later this month, at theguardian.com.
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