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Donating a kidney to a stranger _ a phenomenon quietly on the rise

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ROCHESTER, N.Y. (AP) _ Steve Aman believes if you have something you aren't using, you should give it away.

So he gave a complete stranger one of his kidneys.

``I didn't need two,'' Aman said. ``He needed one.''

His kidney went to Pete Dobrovitz. The two of them attended the same Catholic high school in the 1960s, but they never knew each other.

Dobrovitz, a 49-year-old former television news announcer, had waited 19 wrenching years for a successful transplant. Twice, cadaver kidneys had failed him.

A kidney from a living donor seemed his only salvation. With a healthy donor, doctors could schedule the operation. Dobrovitz could take anti-rejection medicine ahead of time and make sure he was in the best physical shape for the transplant.

The organ itself would be vital and healthy. During his previous transplants, both donor kidneys went into shock and took more than a day to start working.

In desperation, he placed a $60 classified ad last June in a newspaper _ ``WANTED: Your Spare Kidney.''

Within a week, a dozen people came forward. One wanted $10,000. Another talked giddily of daily church visits to ``pray for this miracle.'' Some just hadn't thought their offer through very well. Dobrovitz's own screening narrowed the donors to four.

During testing, the first man discovered he had early signs of cancer. The second was Aman. Even while advances in anti-rejection drugs make genetic matching less relevant, he was an ideal match. ``One in 10 million,'' the doctor said.

More important, though, Aman was acting on what seemed like the right impulses.

A recovering alcoholic, he had joined a self-help group after getting sober a decade ago and became friends with a Tuscarora Indian who helped transform his views on life.

``A lot of the Native nations have this philosophy that if you don't use something, you should give it away,'' said Aman, whose wife, Mary, is part Mohawk.

Taking a break from springtime chores at his tree nursery east of Rochester, Aman said he regarded kidney donation as merely the ``next step,'' and not a very risky one, in a journey of personal discovery.

``I'm really proud of him,'' said his wife. ``I think what he did was the most generous thing one human being can do for another.''

More than 52,000 Americans are signed up for a kidney transplant. Every day, eight of them die waiting.

While the number of kidneys from dead donors has leveled off at around 8,000 a year, more sophisticated drugs and less invasive surgical methods doubled annual living-donor transplants between 1994 and 2001, when 5,944 were performed, according to the United Network for Organ Sharing. Of those, 1,368 donors are not blood relatives of the organ recipients. That figure is a six-fold increase from 1994.

Last year, 26 people donated kidneys anonymously, with no recipient specified.

A rarer cluster that also shows promise of expanding are random donors steering a kidney to someone soliciting help through media channels, notably the Internet.

Transplantation regulators who use medical and psychiatric tests to screen donors find the job trickier in the absence of a genetic or emotional link. They also worry that unorthodox methods for getting off the waiting list might give some an unfair advantage.

``Our knee-jerk reaction is, is this person a saint or a psychopath?'' said Dr. Mark Fox of the University of Rochester, who chairs the ethics committee of the kidney-sharing network in Richmond, Va. ``Motivation is very hard to really get at, so the best we can do is identify those things we consider unacceptable and exclude those people.

``Very often we get a sense from prospective donors that somehow this is going to atone for their sins. On the other hand, we've had people that said, `I've volunteered all my life, I've given 25 gallons of blood, I work for Meals on Wheels,' and this is just an extension of the behavior pattern they've established all along.''

While it's illegal in the United States to sell or pay for an organ, Fox fears that people with more money, media savvy or even better looks might jump the queue by launching a marketing campaign.

Only a few medical centers accept anonymous organ donations. The Washington Regional Transplant Consortium in Falls Church, Va., has had more than 100 inquiries from people willing to donate a kidney. So far, 11 have resulted in transplants.

``We're always looking at ways to find more organs and this is just one,'' said spokeswoman Toni Webb. ``Most people say it was an easy thing to do.''

Born with kidney ailments, Dobrovitz had his first transplant in 1983. The kidney stopped functioning 18 months later; dialysis three times a week kept him alive. Another kidney transplanted in 1987 gave out in 1995. Back to dialysis. Doctors told him a third cadaver kidney held little promise.

Aman, 50, had been thinking of donating a kidney for a year before reading a news article about Dobrovitz's ad for a kidney. One detail caught his eye _ Dobrovitz runs Rochester's Big Brothers-Big Sisters chapter, a child-mentor program where Aman had once volunteered.

Aman's medical costs for the surgery were paid by Medicare and Dobrovitz's health insurance. Four tiny incisions in Aman's abdomen are the only traces from the January operation. His sole kidney has grown bigger to make up for the other's absence, yet his insides feel the same. Anesthesia left him nauseous for a few days but he was back lugging saplings within a month.

``If I had to distill it down to one single reason, it's so that somebody else could have a better life,'' he said. ``If I was going to be debilitated 10 years down the road because of this, then I wouldn't have done it. I'm not a martyr.''

He and Dobrovitz are pushing to create a blind national registry of living donors. Recent studies show the median survival rate of living-kidney recipients is more than 20 years versus 13 years for cadaver-kidney recipients, according to the National Kidney Foundation.

Today, Dobrovitz is free of dialysis' quiet hell and its awful side effects: a heart attack, hearing loss, gall bladder surgery, aching joints, yellowing skin. For seven years, it kept him from traveling very far from home.

``Every place I go now, Steve gets a postcard,'' he said, smiling broadly.

His energy level has soared. He walks more upright, his shoulders squared, his complexion less peaked. This transplant, has given him ``the best chance of long-term survival.''

What Aman did cannot be measured.

``It's changed my life, no question,'' Dobrovitz said. ``Thank you just doesn't cut it.''
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