Failing Kidneys, Broken Heart Show Pitfalls of Organ Donation

Dorothy Zauhar was a 56-year-old divorcee, juggling jobs in nursing and real estate, when she was invited to dinner in 1994 at a friend’s cabin in the northern Wisconsin woods to meet an eligible, Harvard-educated millionaire. Within a week, she and Richard McNutt were inseparable. Within six months, he’d surprised her on her birthday with a 3 1/2-carat diamond engagement ring.

But handsome and strapping as he was, successful as he’d been in commerce, McNutt also was unlucky: His kidneys were failing. Soon he was weary and weak, tethered three times a week to a dialysis machine. Like tens of thousands of people in a nation in which organ donors are scarce, he was desperate for a transplant.

Zauhar offered him one of her kidneys, but doctors ruled her out. So her younger brother stepped forward. In exchange for his left kidney, John Dahl said, he asked his sister’s fiance for three things: a life insurance policy, $5,000 to cover the pay he’d lose while recovering from surgery, and a promise that McNutt would strive always to make his sister happy.

But on the way home from the hospital, his new kidney working fine, her fiance balked at their marriage, Zauhar says. The insurance policy and lost wages, her brother says, never materialized. They now contend that this wealthy businessman deceived them, romancing Zauhar insincerely in hopes that she would lead him to a kidney. They outlined this story in a $150,000 lawsuit against McNutt, accusing him of “theft by swindle of a body organ.”

McNutt’s attorney issued a statement that denied the allegations and expressed gratitude for the kidney donation, which McNutt says he believed was a gift.

Regardless of who wins in court, the case lays bare the treacherous ethical ground that can come along with medical breakthroughs. As the art of transplantation has improved--as doctors have developed new drugs and new skills to prevent patients from rejecting organs that belonged to someone else--the pool of donors has widened. A growing portion of transplanted organs comes now from living donors, including people who are biologically unrelated to the recipients.

For organs from cadavers, there is a nationwide system with strict--albeit controversial--rules that govern the sequence and circumstances under which organs are distributed. But for organs from live donors, the process is less uniform, depending on the luck and determination of individual patients in finding someone willing to give them a kidney or part of their liver, pancreas or lung.

In cases of such “directed” donations, individual transplant programs have designed procedures to determine whether the gift is truly voluntary. It is a federal felony to accept money or other “valuable consideration” for an organ. But doctors and ethicists acknowledge that donors can mask their true motives.

Hospital screening committees “aren’t the cops,” said Arthur Caplan, a medical ethicist who worked for years at the University of Minnesota, where McNutt’s transplant took place. “You aren’t ever going to get a system that [guarantees] people aren’t being bullied, pressured or bought.”

Caplan cited a recent New York case in which a recipient gave his brother-in-law $20,000 for donating a kidney, and one in Minnesota in which someone promised a job in exchange for an organ.

A debate has begun over how best to regulate supply and demand. At one end of the spectrum, some argue that payment should be allowed. At the other, ethicists argue that, in order to minimize exploitation, donation should be narrowed to permit only immediate family members. “In guarding yourself against the worst-case scenario, aren’t you also decreasing the chance” people who need organs will get them, asked James L. Nelson, a medical ethicist at the University of Tennessee.

As the debate swirls, the lawsuit over how McNutt got a new kidney--by far the most common type of transplant in the U.S.--is instructive.

“There was a commitment on Dick’s part that there was going to be a marriage, and John was doing this because he loved me, and my life was going to be a dream,” Zauhar said in an interview at her modest duplex with a fine view of small whitecaps on the slate waters of Lake Superior.

Dahl, her brother, said: “They have to put out a warning to potential donors, that there is a possibility they could be being used.”

McNutt, 64, did not return repeated messages left for him at his home, at his attorney’s office and home, and with two of his sons. His attorney, Nicholas Ostapenko, also did not return numerous phone calls but issued a brief statement calling the lawsuit’s allegations “simply not true.”

The statement confirmed that McNutt had received a kidney from Dahl. “Mr. McNutt will be forever grateful for the donation,” it said. “He also is deeply hurt by this lawsuit. . . . Mr. McNutt fully believed he was the beneficiary of a true gift, and that Mr. Dahl was motivated only by the desire to help a fellow human being.”

The University of Minnesota Hospital, 2 1/2 hours south of here, is a major center of kidney transplantation and was a pioneer in the use of organs from unrelated people. Last year, one-third of the 110 kidney transplants from live donors involved non-blood relatives. They have included spouses, ex-spouses and friends from church choirs.

Zauhar and her brother, who is now 56 and lives outside Minneapolis, have been immersed in medicine all their adult lives. She has worked for 39 years as a licensed practical nurse in a maternity ward at a Duluth hospital. He was a Navy corpsman, then a paramedic before he returned to school to become an RN. He works in a Minneapolis emergency room.

Both of them place an unusually strong value on family, they say. They were two of five children who spent years in a Catholic orphanage here after their parents, both alcoholics, were deemed unfit to rear them.

Boys and girls were segregated in the orphanage. After the siblings were taken in by separate foster families, they saw each other perhaps once a year. As a result, Dahl said, since they have been adults “living a normal life, we are very close.”

Zauhar married at 22. Her husband was a television repairman who later worked for a printing company. They had three children in the 23 years before they divorced in 1982.

McNutt was the founder of Inter-City Oil Co., a local chain of gas stations and convenience stores. He owns a $570,000 condominium near Palm Beach, Fla., and a vacation house in Iron River, Wis., along with the large lakefront home in Duluth that Zauhar says he built to share with her.

His third marriage ended in divorce, Florida records show, three months before the April night he and Zauhar met. From the start, she was smitten by this tall, worldly businessman with charming manners and dazzling intelligence.

They had known each other only briefly when he told her he had congenital kidney problems that were, as he reached 60, getting much worse. By that August, he was on dialysis at Miller-Dwan Medical Center in downtown Duluth. Friends would ask her, “What are you getting into?” she recalled. “It wasn’t a thought. I loved him. I really loved him.”

She wanted him to have one of her kidneys. But when she got to Minneapolis to begin the screening, she was disqualified by the last item on a questionnaire. Yes, she had once developed a blood clot during surgery.

McNutt did not sign up on the national waiting list for cadaveric donors maintained by the United Network of Organ Sharing in Richmond. There are 37,532 people waiting at the moment for a kidney. Last year, fewer than 9,000 people on the waiting list got transplants. Another 3,500 received kidneys from live donors.

Instead, McNutt widened his search. His twin sister and his eight children from previous marriages did not volunteer, according to Zauhar’s lawsuit. He thought he had found a donor, she said, in a lifelong friend, whose own life he had helped to save as a boy. But that fell through, she added.

McNutt was spending more time on dialysis. Zauhar tried again to persuade University of Minnesota doctors to accept her and, again, was turned down.

It had been months earlier, at a New Year’s party at the Duluth house that McNutt and Zauhar were by then sharing, that she had mentioned to her brother that perhaps he could become the donor. Dahl wanted time to discuss the idea with his wife, to get to know his sister’s fiance better. By the spring of 1996, he consented and proved a proper match.

Barbara Elick, administrative director of the University of Minnesota’s transplant program, would not discuss an individual case. But she said the program uses a careful, confidential screening process in which potential donors and recipients meet separately with a team that includes a surgeon, kidney specialist, and social worker. They emphasize the importance of altruism, Elick said. “Donors are always told, ‘You have to do this for yourself. What happens if the kidney doesn’t work? Can you handle that?’ ”

Despite the prohibition against “valuable consideration,” Dahl said he told the screening team about the $5,000 and the life insurance policy he had asked McNutt to provide. “I didn’t do any legal research,” he said. “But I told them, and they didn’t object.”

So on July 2, 1996, in a five-hour operation that left him with two fewer ribs and a foot-long scar, Dahl relinquished his left kidney to the man he expected would become his brother-in-law. “This was for my sister,” he said. “She was, as far as I was concerned, the recipient of the kidney, and she decided to give it to Dick.”

But the marriage never materialized.

According to Zauhar, McNutt had first suggested that their wedding take place on Sept. 23, 1995, a date near both their birthdays when the lush foliage of northern Minnesota is at its most brilliant. She had picked out a dress, but had made few other preparations for what was to be a small ceremony at their home. A few days ahead of time, she said, he told her they couldn’t marry on that date because he needed to travel to Florida to work out their prenuptial agreement.

The next wedding date was set for July 1996, a few weeks after his transplant. “For this one, I had invitations made. I had dresses made,” Zauhar said.

But after the surgery, before they’d gotten out of the hospital driveway, Zauhar said, McNutt told her the wedding would have to be postponed again because doctors had advised him to avoid stress for the next three months.

Zauhar was beginning to suspect her fiance had another girlfriend. A woman--one of the dialysis nurses from the local hospital--was calling their house to speak with him, she said, and McNutt was asking her not to accompany him on certain trips. Finally, last spring, a relative of McNutt’s confirmed Zauhar’s fears about the other woman. Last spring, Zauhar moved out.

According to a marriage certificate on file in Bayfield County, Wis., McNutt and Patti Sue Bennett, 42, were married on June 28, 1997.

Zauhar still has the ring, a marquise diamond valued at $21,500. But she and her brother believe McNutt has deprived them of two things that are more fundamental: his kidney and her trust. “I feel that Dick used me,” Zauhar said. “He used my love so he could have a better life.”

Despite their experience, despite the gossip in her beauty parlor and the talk on the radio since the case hit the local newspaper, Zauhar and her brother still believe in the value of donating organs.

“I’m happy the kidney is working,” Dahl said. “It could have gone to a better person.”