|Detail from "Still," by Damien Hirst, at the Art Institute of Chicago
Last week, I wrote about a woman who donated a kidney to a stranger. Which reminded me: I had been here before, not only focusing on a young lady making an "altruistic" donation, but observing the surgery at University of Chicago Hospitals. I enjoyed revisiting the pair of columns, and thought you might too. Today we meet the donor, tomorrow we watch the surgery.
Before the sun comes up Tuesday, Rachel Garneau's boyfriend will drive her from her home in Elmhurst to the University of Chicago Medical Center, where a surgeon will operate on this perfectly healthy 20-year old college junior and remove her left kidney.
Typically, this kind of donation is made to save the life of a loved one—you give your kidney to a brother or sister, for instance, suffering from kidney failure. Or, if you are not a suitable donor for your relative, you give a kidney into the national donation system, and somebody angling for a kidney for their loved one gives one to yours, forming a "cluster" of donation that can involve half a dozen people.
But Garneau's four siblings are fine. She doesn't know anyone who needs a kidney. She just wants to donate hers.
"We have a young lady, an incredibly generous person who said, 'I want to give up my kidney to just anybody,'" said Dr. Yolanda T. Becker, the transplant surgeon who will perform the operation and director of the hospital's kidney program.
"I'm excited," said Garneau, a few days before the surgery. "I'm really looking forward to it."
Altruistic donation of a kidney is not as rare as one might imagine. Nearly 1,000 people have done it nationwide. There is a website, Matchingdonors.com, that says it facilitated 100 organ donations and has 2,000 people signed up hoping to donate.
Still, the number of people willing to give kidneys is nowhere near the need. The waiting list for kidneys nationwide has 82,000 names on it, and with dialysis such a taxing procedure, 12 people a day die in the U.S. waiting for a kidney to become available.
Garneau is majoring in anthropology at Notre Dame, and is planning to study in Rome in the fall. She plays intramural volleyball. Eventually, she'd like to spend a few years in the Peace Corps, then start a family.
What inspired her to consider this now?
"I honestly don't remember what got me into this at all," she said. "I first started thinking about this three years ago, when I was 17. I've never known anybody who had kidney problems, I never knew anybody who had serious medical issues. One day, I started thinking about it, doing the research ... a few hours later, I went downstairs I told my parents I wanted to donate my kidney."
Her mother and father reacted the way most parents would.
"They sort of ignored me at first because they thought I was joking," she said. "When they realized I was considering it, they said, 'No. End of discussion.' They said the surgery is risky, what if you get hurt? What if you die? It seemed one of those things you say on a whim."
But she persisted. Why?
"Honestly, I don't know," she said. "I don't think it's a religious thing. I was raised Catholic. I never really felt like God was a part of this, necessarily. I guess it could be, but I never really felt that way. I decided to do it. I got this idea in my head and it won't go away. I can't not try to do something. My family has always been very giving, very charitable toward others. That could be a part of it."
This kind of altruism is certainly nothing new for Garneau. When she was 15 she told her parents she wanted to help people overseas.
"I decided I wanted to volunteer in Africa," she said. "They let me go with a friend for a month when I was 16. I went to Ghana to work in an orphanage."
Her father, who works as a meat cutter, declined to be interviewed; her mother, a special education teacher, died suddenly in 2008 from an infection picked up in a hospital a month after she was diagnosed with leukemia—though Garneau points out that she decided to donate her kidney before she knew her mother was sick.
Garneau approached the hospital last fall and assumed she'd donate her kidney by Christmas.
Instead, she had half a year of interviews and medical tests.
"We really put her through the wringer to make sure it was something she really, really wanted to do," said Dr. Becker. "The potential donor is seen by a social worker, a psychologist, a living donor advocate, to make sure we are not doing anything bad."
The hospital held an ethics conference with two dozen doctors, nurses, social workers and psychologists to discuss the case.
"Some were arguing very vehemently that there is no medical benefit to her," said Dr. Becker. "Some people felt she was very young."
Many would-be donors are sent away.
"About 30 or 40 percent we reject, for all kinds of reasons," said Dr. Becker. "They don't realize just what they're up against. We want to give them multiple opportunities to ask questions or back out. We made her come back almost half a dozen times. She's so unusual, so young. We want to make sure we're protecting our donors. I'm not going to whack somebody over the head and take their kidney out."
What about the Hippocratic Oath, what about "first do no harm"?
"She's an adult," said Dr. Becker. "She gave me permission. I did speak with her father, just to give him the facts. The operation is risky—any time you operate, there is a minute but very real chance of death. Still, I feel very comfortable that this young lady has given informed consent. She knows what she's getting into. If I didn't feel comfortable, I wouldn't proceed."
Dr. Becker has done this before. I wondered how she felt, taking a kidney from a perfectly healthy young woman.
"To be honest, in some ways it's more stressful to take one out of healthy person than to put one into a sick person, because you are taking something away from that healthy person," she said. "It's not an operation they need to have done. They're not sick. There is a slightly added level of stress."
I mentioned to Dr. Becker that, in my view, if Garneau were signing up for the Marines we wouldn't think twice of applauding her selflessness, even if she were going to fight in Afghanistan, where she could possibly be injured in a far more grievous way than losing a kidney (your remaining kidney enlarges to pick up the slack, and since kidney disease typically strikes both kidneys, having an extra is only useful in the case of physical trauma, like a car accident).
"That was the argument brought up at the ethics conference," she said. "It's less dangerous than going to Iraq and getting shot."
Garneau couldn't quite put her finger on her exact motive. What does Dr. Becker think of what Garneau is doing?
"I just think she's on a higher moral plane," she said. "She's great. She's awesome. She is just an incredibly generous person who saw this is the right thing to do."
—Originally published in the Sun-Times May 30, 2011