Donating a Miracle

The problem with having a phone company message center rather than an answering machine is that the messages get erased after a certain number of weeks. Zafar Mehdi didn’t know this until, for something like the 7,000th time, he went to listen to the message that saved his wife’s life and found that it was gone.

It was the kind of message a person would want to save, the kind of message you usually only get in a really good dream, the kind that couldn’t possibly be real. Except it was.

Although the actual recording has been lost, all of the parties involved--Zafar and his wife, Carrie, and the caller, Julie Michaels--remember it quite clearly. It went like this: “Hi, Carrie, this is Julie Michaels. You may not remember me, but we met briefly at that holiday party and sat next to each other at the Sierra Breeding Club meeting. Anyway, I heard you need a kidney, and if it turns out we match, I would be honored if you would accept one of mine.”

Zafar was the first to hear the message. “Honey,” he called into the bedroom, his voice rising a bit, “Carrie, you should listen to this message. I think this woman is sincere.”

Carrie listened to the message and stared at her husband. She listened to the message and tried not to laugh or cry, tried to remain absolutely calm. She listened to the message and tried to remember, tried to conjure an image of this woman, this Julie Michaels.

Fatal Kidney Disease

In 1987, Carrie had been diagnosed with polycystic kidney disease, a genetic degenerative condition that leads invariably to the loss of kidney function. Her grandfather had died of it; her father had died of it. In 1997, her 41-year-old brother died of complications associated with the illness.

In 2000, Carrie went into renal failure and had to go on dialysis. Extreme fatigue soon forced her to quit her job as an interior decorator. In spring 2001, she got on the list at UCLA’s transplant program; the average wait is six years for what would probably be a kidney harvested from a cadaver. Such an organ might last eight years, a kidney from a living donor twice that. At the time of Julie’s call, Carrie was 48.

Twenty or 30 times, she punched the replay button and listened to the message before she could summon the courage to call the woman back. Carrie tried to explain to Julie that although she appreciated the offer very, very much, Julie needed to know that there was a lot involved in donating a kidney to a stranger. Tests, days of tests, weeks of tests, to determine if the women’s blood and tissue types were compatible, to see if Julie was healthy enough to donate an organ and if she had any predisposition to diabetes or other conditions that might trouble her own kidneys in the future.

“Oh, I know all that,” Julie said. She worked for a medical center, as an executive assistant, and she had already talked to their transplant specialists and a nephrologist. Her only concern had been what life would be like with just one kidney. Same as before, she was told; people only need one kidney.

“I’m O positive,” Carrie said, facing the first hurdle.

“Perfect, so am I,” said Julie. From that moment on, she would say later, she knew it was all going to work out just fine.

Well, OK, said Carrie, not knowing quite what to say--what do you say when a woman you’ve met only three times offers you one of her organs?--I’ll call UCLA and we’ll go from there. Great, said Julie, and then they hung up. Carrie called Suzanne McGuire, a coordinator of UCLA’s kidney and transplant programs. McGuire told her they could not call Julie--transplant programs must be excruciatingly careful to avoid an appearance of solicitation. Julie would have to call them.

Carrie, McGuire said, was understandably very excited and emotional. McGuire tried to sound optimistic but realistic. Most living donors are blood relations to the recipients; those who aren’t invariably have long-term emotional ties. “We don’t get a lot of cases of relative strangers,” McGuire said. “And it’s something we are cautious about because there’s always a chance there is another motive involved, usually money. We encourage the recipient to give such a thing a little thought--I asked her how well she knew this person, did she feel comfortable receiving an organ from her.”

What Carrie knew about Julie made her feel perfectly comfortable. In their first conversation, and as they subsequently grew to be friends, Julie told her this was an unconditional offer. Carrie had no misgivings. She called Julie and gave her McGuire’s number. Less than a month later, Julie was on her way to UCLA for the first round of tests.

Both Dachshund Lovers

Here is the most important thing Carrie knew about Julie when Julie made her offer: Like Carrie, she was the passionate owner of dachshunds. In August 2000, one of Julie’s dogs died, of liver and kidney failure. It was nine months before Julie would allow herself to consider getting another dog; when she did, she chose a puppy with sight problems. She took the new dog, Dixie, to an informal gathering, and judging, of dachshunds. Carrie gave the little dog, who had to be carried into the ring, fourth prize.

Here is the most important thing Julie knew about Carrie: She had a son, Gregory, 18, who looked strikingly like Julie’s own son, Andrew, 24. In January, Julie saw the two of them across the crowd of a holiday party. She could not get over the resemblance between the two young men.

A month after that holiday party, she wound up sitting next to Carrie at a dog club meeting and when Carrie suggested organizing a fund-raiser to start a dachshund rescue, Julie could not have agreed more. Then she remembered the boy who looked like her boy and felt an instant kinship.

After the meeting, she asked a friend about Carrie, and the woman happened to mention that Carrie needed a kidney. Again, Julie thought of Carrie’s child. Julie looked at the woman, and then at the room full of people, many of whom knew Carrie quite well. And she asked what seemed to her a natural question.

“Has anyone offered her one?” she asked. The woman looked a bit taken aback and shook her head. Julie didn’t understand it. Here was this perfectly nice woman who needed something desperately, and yet no one was offering. She heard something almost as if it were whispered in her ear. “Offer yours,” that something said.

Julie is 4 feet, 9 inches tall, which means she is too small to even give a full pint of blood. Six years before, after watching her husband donate platelets at the hospital where they then both worked, she had had her platelets typed and put on file. Eventually, she donated some to a boy who needed a bone marrow transplant. Beyond that, she had no connection with organ or tissue donation at all, knew of no recipients, no other donors.

But it seemed to her, when she thought about it, a very obvious and normal thing to do.

For Carrie, finding a living donor had seemed an impossibility. Her mother was too old, her brother had been her only sibling. There was a cousin she wasn’t close to, and her husband’s blood type did not match hers. She, too, wondered about some of her friends, whether they might match, but she could never bring herself to ask them.

“You can’t ask,” she said. “You just can’t. You tell people about your condition and you hope that someone might offer, but you can never ask. And it is hard. Because I would look at some people who I was close to and wonder why they didn’t offer. I would think, if it were me, I would offer, and maybe they didn’t care about me the same way I cared about them. I didn’t want to think like that. I really hated it. But you can’t not.”

Each year, 5,000 Americans die while on waiting lists for organ transplants. Last year, only 14% of living kidney donations were made by people unrelated to the recipient, according to the United Network for Organ Sharing, a national database for organ transplants. The “unrelated” category is not specific, but it is likely that most of the donations involved a previous relationship--the donors were friends, co-workers or fellow parishioners of the recipient or their family--although half of 1% were given by anonymous donors to various transplant programs. “It is not unheard of for a relative stranger to donate,” says Ann Plaschke, a spokeswoman for the database, “but it is pretty rare.”

Julie waited a couple of weeks to see if the urge to make the offer would go away. It didn’t. One night she approached her husband in their Placentia home. “Honey,” she said, “how would you feel if I offered to donate my kidney to that woman I told you about?”

Jeff Michaels was not surprised at all. He knew his wife, knew she believed if not in a church-defined God then in a universal power that often guided our actions, our lives. He had heard something in the back of her voice when she had told him about Carrie a week or so before, about how no one had offered her a kidney. He too remembered Carrie’s son, the resemblance to his son. He didn’t even blink. “Tell you what,” he said, “if you’re not a match, then I’ll get tested too.”

July 15 was their 25th wedding anniversary. The year before, they had made plans to spend it in Tahiti. After she decided to donate her kidney, it became clear that the timing would not work out so they canceled their trip and booked a cruise. When it turned out that the operation would be scheduled in mid-July, they canceled the cruise as well.

Julie shrugs it off. “I would have liked to go to Tahiti,” she said, “but this seemed more rewarding.”

The first tests on March 26 revealed that although they were not a perfect tissue match, they were compatible. New drugs have made a perfect tissue match unnecessary, McGuire said, although a genetic match is always preferable. The two women were about the same age, each had had similar childhood illnesses and only one pregnancy, so their antigens were remarkably similar.

“We later found out we each had relatives that came over on the Mayflower,” said Julie. “So maybe we are related. I mean, that was a very small boat.”

In April, Julie had her psychiatric consultation, or as she puts it, “the foil-helmet test. They wanted to make sure I didn’t hear voices coming from the TV when it was turned off,” she said, “that I didn’t hear God talking directly to me, that I wasn’t doing this because I was crazy. I kept telling them, I just felt in my gut that it was the right thing to do.”

All potential donors are required to undergo an evaluation to protect both the donor and the recipient. “You hear a story like this and you think the person must be crazy,” said Dr. Albin Gritsch, surgical director of renal transplant. “But there are a lot of people who do generous and altruistic things. We just need to make sure that altruism is the real motivation.”

According to Gritsch, the waiting list at UCLA and other transplant programs has grown significantly as demand for transplants--spurred by high success rates--outstrips supply. In the last few years, nonrelative donors have also increased, he said, as those on the waiting list cast about outside their families for other resources.

Julie passed the psych test, and all the physical evaluations. On June 1, the two women, who had talked to each other on the phone almost every day for the past two months, met each other for the first time since Julie’s offer. The two couples went out to dinner at a restaurant in Costa Mesa. If anyone had any doubts, they were dispelled by this evening.

“I have never laughed so hard in my life,” said Julie. “It was like it was meant to be.”

“We felt like we had known each other for years,” said Jeff.

On a recent Saturday evening, they are once again gathered for dinner, this time in the Mehdis’ Glendale home. Dachshund statues stalk across the coffee table in the living room, ribbons from Carrie’s champions spill from a bench in the dining room. Julie is petting one of the dogs. Carrie looks at them and says: “You know, it’s funny to think that if it hadn’t been for those dogs, this would have never happened.”

Both of the women have been home from the hospital for weeks--after the July 24 surgery, Julie was in the hospital for only two days, Carrie for six. Julie is happy to show off her scars, or at least the four that are above her bellybutton--inch-long marks where the laparoscopes were inserted. She was on the table for almost four hours. To remove a kidney, the surgeons had to put her on her side, with her hands over her head, and keep her there; the most pain she suffered later was in her back and neck from being in that position so long.

Julie went under the knife first. When her kidney was removed, it was taken to an adjoining operating theater and put right into Carrie. The moment it was attached, Carrie began producing urine.

‘Things Can Work Out’

“Look at her,” Julie says, as Carrie rises from the sofa to serve dinner. “She looks great; she looks like it never happened. I also think it’s great for Gregory,” she says when Carrie has left the room, “for him to see that you don’t have to die from this, that things can work out.”

Gregory, as it turns out, also inherited the condition though has shown no symptoms; Zafar is a match for him and could donate one of his kidneys if the need were to arise.

This is the second dinner the couples have had since the operation; this time Julie and Jeff brought the bottle of Dom Perignon they had been saving for their anniversary. Both the women are allowed to drink alcohol, neither of their diets has changed, although Carrie will take anti-rejection drugs for the rest of her life. The initial high dosage has left her ankles and cheeks puffy, but that will soon disappear. Julie is aware that she no longer has a spare kidney and so must be careful with the one she’s got; she was told she shouldn’t skydive or practice martial arts, limitations she thinks she can live with. “I went skydiving on my 30th birthday,” she says. “That was enough.”

The women seem easy with each other. They both say they feel they have gained a sister.

“It’s just amazing,” says Carrie. “We have the same sense of humor, the same political views, we like the same food.”

They tell and retell the story of what has happened to them just as new mothers or the survivors of a calamity work and rework the narrative of their ordeals. They want other people to know that you can donate a kidney to a stranger and be better, not worse for it. “It’s a miracle,” says Carrie, calmly, “that I’ve now got a piece of Julie inside me ... and a year ago we didn’t know each other.”

Six months after hearing a voice on her phone message center, she finally believes it was real.