by George Taniwaki

The 2013 American Transplant Congress was held in Seattle two weeks ago. Two papers were presented that are of interest for kidney donors. Both of them discuss the issue of lower renal function after donation.

Recent kidney donors are experiencing greater declines in eGFR than in past

In the first paper entitled “First-Year Renal Function Changes among Living Kidney Donors (LKD) in the United States”, researchers led by Emily Heaphy at the Cleveland Clinic compared the short-term (one-year) change in renal function of donors. They compared results by race (white/Caucasian, Hispanic, African-American, Asian, and Native American), age, gender, obesity (as measured by body mass index), blood pressure, and by year of donation (from 2004 to 2011).

The findings are that all donors have higher creatinine levels and lower estimated glomerular filtration rate (eGFR) post-surgery. This is not a surprise. They also found differences by demographic characteristics. African-American, Asian, and Native American donors had bigger increases in creatinine than white/Caucasian or Hispanic donors.

Older donors, especially over 50, had greater increases than younger ones. Men had greater increases than women. There were no differences based on BMI or BP. The one-year decline in eGFR has been getting bigger over time. Donors in 2004 had an average 24.9ml/min drop while donors in 2011 had a 29.9ml/min drop.

The study was retrospective and was based on the data from over 31,000 living kidney donors in the Scientific Registry of Transplant Recipients (SRTR). As mentioned in previous blog posts (for example Nov 2009), donors are not tracked, so data beyond one or two years past donation is generally not available. Thus, it is not possible to say what the long-term consequences of low eGFR will be. That is, we don’t know if low eGFR after surgery is an indicator of any adverse health effects in the future. Also, there is no explanation why the decrease in eGFR is greater today than in the past.

The results of this study are of special interest to me, since I  am Asian, male, and was  51 years old when I made my donation in 2010.

Low eGFR after donation does not lead to kidney disease

On the positive side, a second paper entitled “Low GFR after Kidney Donation Is Not Chronic Kidney Disease” provides evidence to an idea I posited in an Apr 2011 blog post.

The abstract of the study says, “Many kidney donors have an estimated GFR<60 mL/min/1.73m early post-donation and thus meet with criteria of chronic kidney disease stage 3 (CKD3). However, the prognosis of a low GFR with one healthy kidney may not be equivalent to the prognosis of the same GFR with two diseased kidneys.”

A study led by Laura de Vries and colleagues at University Medical Center Groningen in the Netherlands followed two groups, patients with early stage CKD and recent donors, for an average of 4.7 years. At the start of the study the CKD patients had an average GFR of 67 ml/min compared to 71 for the donors. By the end of the study, the patients’ average GFR had fallen to 63ml/min (slope of –1-4ml/min/yr) while the donors had risen to 73 (slope of +1.8).

The results are based on a small prospective study of 57 post-donation kidney donors and 57 CKD patients who were matched for age, gender, GFR, and time of follow-up. GFR was measured rather than estimated, using 125I-iothalamate tracer rather than creatinine. Kidney function slope was calculated as (GFR follow-up – baseline GFR)/duration of follow-up, giving a slope in ml/min/year.


Change in GFR for patients and donors over four years


Here’s a riddle.

Question: I donated a kidney anonymously on Wednesday, September 29, 2010. This is a rare act. Perhaps 300 people worldwide did it last year. I also write extensively about kidney donation. I was reading Renal & Urology News May 2011 and I saw a story written by a person explaining why he/she donated a kidney to a stranger on Wednesday, September 29, 2010. But it wasn’t written by me. It was a weird experience reading the story about someone who is very similar to me. (I encourage you to read the article.) What are the odds that two people who enjoy writing also donate a kidney anonymously on the same day?

Short answer: Ex post, p=1.

Long answer: Before the two surgeries occur (called ex ante), the joint probability that my surgery (let’s call it event A) occurs on the same day as the other donor (let’s call it event B) is written as P(AB). We want to break this probability into two parts. First is the probability of my surgery happening on a particular day given that the other person donates the same day. This is written as P(A|B). Similarly, the probability of the other donor’s surgery date given mine is P(B|A) and the joint probability is obtained by multiplying the two together, P(AB) = P(A|B)*P(B|A).

In this case, I am certain (P>.99) that the date of my surgery was not influenced by the other donor. I was unaware of the existence of the other donor until I saw the story in Renal & Urology News. Thus, we can write P(A|B) = P(A).

Further, I will assume that the other donor’s surgery date was unaffected by my date and so P(B|A) = P(B). Thus, I ignore the possibility that the other donor or his/her surgeons read this blog and selected the donation date to match mine. I will also ignore the possibility of spooky effects like quantum entanglement, ESP, and God’s will forcing the two surgery dates to be identical.

Now we have P(AB) = P(A|B)*P(B|A) = P(A)*P(B).

Now, I will assume that the surgery dates for both me and the other donor are random and independent. If this is true, then P(B) = P(A). Substituting gives us P(A)*P(B) = P(A)^2.

Actually, this is not quite true. Elective surgeries are not randomly scheduled. For instance, surgeons like everyone else, want their weekends free and dislike scheduling elective surgeries on Saturday or Sunday. Similarly, surgeons like to visit their patients for two days after surgeries, but want to avoid coming in on weekends. Thus, they don’t schedule elective surgeries on Thursdays or Fridays. Finally, emergency care patients who enter the hospital on weekends are often taken into surgery on Monday. Thus, elective surgeries are nearly always scheduled on Tuesdays and Wednesdays. Eliminating the weeks of New Years, Christmas, and Thanksgiving, the Tuesdays after 3-day weekends, and allowing time off for vacations leaves about 90 possible surgery dates each year.

Now, there are about 300 other nondirected donors, so on average over 3 (300/90) nondirected donors will have surgery on the same day. Note however, that it is unlikely that the doctors at my hospital are on vacation the same dates as the doctors at the other donor’s hospital, or have the same holiday schedule, so this estimate isn’t quite right. Further, not all 300 donors like to write. And not all the writers will be English speakers. Now we have a complicated mess.

Yuck. Let’s start over. Instead, let’s look at the probability that an event will occur after we know the outcome, called ex post. It is always either 100% (it happened) or 0% (it didn’t happen). In this case, we know it happened so P=1.

[Update: I clarified the logic. I also changed the wording to indicate that I don’t know the gender of the other donor. On initial reading of the story, I thought it was written by a man. Now I think it is a woman. But since the writer is anonymous, I can’t be sure. About 60% of anonymous donors are female. (But that doesn’t mean there is a 60% chance that I am female.)]

by George Taniwaki

The most common measure of kidney function is called the glomerular filtration rate (GFR). Traditionally, a GFR level of 90 or higher (measured in mL/min/1.73m^2) is considered normal. Kidney disease is categorized in stages from 1 to 5 with each stage defined by a GFR range. Patients with chronic kidney disease (CKD) generally progress though the stages until they reach stage 5. At this point they will require renal replacement therapy, meaning dialysis or a transplant. Details are given in the table below.


Estimated GFR (mL/min/1.73m2)
0 Normal kidney >90
1 Slight kidney damage but with normal or increased filtration >90
2 Mild decrease in kidney function 60-89
3 Moderate decrease in kidney function 30-59
4 Severe decrease in kidney function 15-29
5 Kidney failure (requires replacement therapy) <15

Traditional definitions of the five stages of kidney disease, they may not apply to kidney donors with one kidney

Patients with stage 4 and stage 5 are much more likely to also have hypertension (chronic high blood pressure) and are more likely to die from a cardiac event (heart failure). About 20% of patients in these categories die each year.

Estimated versus measured GFR

Before looking at the results of studies, let’s define GFR and how it is measured. Glomerular filtration rate is the volume of fluid (in mL) that can be filtered from the renal (kidney) glomerular capillaries per unit time (in min) adjusted for the body surface area (BSA) of the patient (that’s the reason the 1.73m^2 appears in the denominator; it represents the height of the average male of about 5 foot-8 inches).

The most accurate way to measure filtration rate is to use find a chemical that has a steady level in the blood, is completely filtered by the kidneys (arrow 1 in figure below) and is not reabsorbed (2) or secreted (3).


Schematic of function of kidney. Image from Wikipedia

The most common chemical used in GFR measurement is a protein called creatinine. It is a waste product from muscle cells and is produced at a fairly steady rate. As described in a Mar 2008 blog post, a test called the creatinine clearance rate (CCR) can be used to measure the amount of creatinine removed from the blood and excreted in the urine in a 24 hour period. A blood sample is taken to measure the concentration of creatinine in the plasma. These two measurements are used to calculate GFR. Since the concentration in both the urine and plasma are directly measured, this is called measured GFR or mGFR.

Collecting a 24 hour sample of urine is cumbersome and it is hard to get patients to do it correctly. (I’ve done it three times in the past two years while being evaluated as a kidney donor, so I’ve become accustomed to the routine.) To avoid the 24-hour urine collection, doctors estimate the GFR using just the serum concentration. These estimates are based on the person’s age (muscle mass declines with age), gender (women have less muscle mass then men), weight (thin people have less muscle mass), and race (blacks have higher muscle mass than whites). GFR calculated in this way is called estimated GFR or eGFR.

A scary story for donors

After their surgeries, some kidney donors are told they have low GFR, below 60 ml/min/1.73m^2, and thus have Stage 2 chronic kidney disease. A recent paper presented at the 26th Annual Congress Eur. Assoc. Urology reports that one year after undergoing a live donor nephrectomy, more than half of donors will have CKD as defined by the traditional stages. The paper is described in Renal and Urology News Mar 2011.

In the study, a team led by Nilay S. Patel examined data from 3,424 living donors in the United Kingdom who had preoperative and one-year follow-up data available. “The fall in GFR [following donation] has been underestimated to date,” said Dr. Patel. Potential donors should be informed of the risk of renal function decline following donation.

Well, this is rather scary. Is it safe to donate a kidney?

Rising GFR after donation

In the study above, Dr. Patel notes that after the initial decline in GFR, it appears to remain stable for at least five years. Further, donors rarely suffered adverse cardiovascular events or cardiac mortality.

Among the 784 donors with five years of follow-up data available, only 0.4% experienced non-fatal cardiac events and 0.05% died from cardiac events. New-onset hypertension was diagnosed in 10% of donors.

This is reassuring. Let’s take a look at the results from some other recent studies that investigated GFR after kidney donation.

A study of 237 Japanese donors is reported in Clin. Exper. Nephr. Aug 2010. The authors found that the median estimated GFR at the time of donation was 79, meaning that many donors could be considered to have stage 2 kidney disease. After one year, the average decrease in eGFR was down 40% to 48, meaning most (85%) Japanese kidney donors would be considered having stage 3 kidney disease.

This sounds bad. However, data collected over the next four years shows that on average, the eGFR rose by 1 mg/mL/1.73m^2 per year. This upward change was seen regardless of the absolute values of estimated GFR at the time of donation or one year afterwards. This is unexpected because GFR generally declines with age. Thus, among these Japanese kidney donors, low GFR was not a sign that kidney disease will progress.

A Swedish study published in Nephr. Dialy. Transpl. May 2011 (subscription required) and described in Renal and Urology News Mar 2011 confirms that people who donate kidneys experience an increase in estimated GFR for more than a decade after nephrectomy.

The researchers looked at 573 kidney donors who had a mean age of 47 years at the time of donation and with a mean time since donation of 14 years.

The findings suggest that for 30-year old donors, the median estimated GFR increases for 17 years, then remains constant for 8 years, and then declines thereafter. For a 50-year old donor, the median eGFR increases for 13 years and then declines. The gains were less pronounced for measured GFR. The data, developed using multiregression analysis are shown below.

Median_eGFR Median_mGFR

Curves showing median eGFR (left) and median mGFR (right) for a typical 30-year-old donor (black line) and 50-year-old donor (gray line). Graphics from Nephr. Dialy. Transpl.

Difficulty in measuring GFR

Finally, there is some research that indicates that using the standard calculations for measured GFR and estimated GFR is not appropriate for kidney donors and are not reliable ways to determine if they have kidney disease. An article in Clin. J. Amer. Soc. Nephr. Jan 2010 reports that eGFR underestimated actual kidney function while  mGFR overestimated it. The error was larger the older the donor.

Mark Wedel, a retired MD and kidney transplant recipient, provides the following comment on these studies.

“I think the primary question [these studies raise] is whether or not this change is what one would expect [to occur in these donors] after having half their renal mass removed, and secondarily, does that GFR actually increase as the remaining kidney hypertrophies in response to the donation nephrectomy.

“I’m not aware of any serial data on renal mass following nephrectomy. Ideally, I’d like to see a study correlating GFR with renal mass plotted against time [since transplant].”

Comparing donors to patients

I have drawn two graphs below to represent the change in GFR for two people. On the left is GFR data plotted for a hypothetical 40-year-old woman. Her GFR declines for two years going from 98 to 78 before she is diagnosed as having kidney disease. At this point, which we will call year 0, she has stage 2 kidney disease. Over the following four years her GFR continues to decline and reaches 40 in year 4 meaning she is now at stage 3. If the trend continues we can expect her to reach stage 5 eventually.

On the right is GFR data plotted for another hypothetical 40-year-old woman. Her GFR is relatively flat for two years until she donates a kidney. At her first medical examination after her donation, the lab test show her GFR is 66. We will call this year 0. Her GFR is lower than the 78 level that was used to diagnose the woman in the paragraph above as having stage 2 kidney disease. Should she be concerned? Maybe, maybe not. Let’s see what happens over then next four years. In the case I have illustrated, her annual GFR test results are 76, 83, 88 and  86. These GFR values are still below normal and lower than her pre-nephrectomy values. However, they are trending upward rather than downward. Saying this woman has stage 2 or stage 1 kidney disease doesn’t seem accurate or useful in describing her situation.

This does not mean you can ignore the lab results. However, it means you need to look at the trend as well as the absolute value when evaluating GFR results after a kidney donation.

Note that the same analysis holds true for the kidney transplant recipient as well. Checking to see if GFR is trending upward or downward can play an important role in deciding if the transplant is successful.

GFRpatient   GFRdonor

Change in GFR for a hypothetical kidney patient (left) and a hypothetical kidney donor (right) both show below normal kidney function, but only the one on the left should be considered kidney disease. Graphics by George Taniwaki

[Update: Added byline. Fixed a numerical error and clarified the CKD level.]

This is a continuation of the story of two of my former coworkers at Quark, David Allen who was suddenly diagnosed with end-stage kidney disease and Paul Brown who donated a kidney to David.

On May 14, 2000, David and Paul checked in to the University of Colorado Hospital in Denver for their separate surgeries. In the morning, just prior to the start of surgery, Paul remembers being on a gurney in a hallway outside the operating room after being sedated. He recalls seeing David prior to being rolled into their adjoining operating rooms. Says Paul,

“I think I was making some jokes and he was laughing. But that may have been a hallucination.”

Paul’s donor nephrectomy (kidney removal surgery) was done laparoscopically, which involved a single 5-inch lateral (vertical) incision in his abdomen through which the kidney was extracted and two smaller incision for inserting the instruments and a camera. Once Paul’s kidney was recovered, it was cleaned and taken the operating room where David was already prepped to receive the kidney. Paul’s surgery was completed and he was taken to a post-anesthesia care unit (PACU) a few hours before David’s surgery was finished. Despite completing his surgery first, Paul recalls that he spent more time in post-operative recovery than David before being taken to his room.

“After waking up, the pain was so intense. It was unbelievable. The morphine didn’t help. David and I shared a room. I remember he was already in the room and coherent when I came in. He looked a lot better than me. Pretty soon, they [the hospital staff] wanted us to get up and walk around. It wasn’t a long walk, that’s for sure. Maybe once around the floor. It took us a good ten minutes. A shuffle walk, 3 or 4 inches at a time.”

Paul was out of the hospital after three days and was back to work in two weeks. He continues,

There’s a big difference between being able to get to work and sit at a desk and getting back to normal. Prior to surgery I was skiing every weekend, hiking, and playing soccer. [When I went in to get tested,] the doctors were quite surprised by how low my pulse was and by my low blood pressure. [After the surgery,] I was really shocked how long it took for me to get back to normal. I didn’t have the lung capacity. It was like I was out of shape. I would say I eventually got back to normal a year later. [Since then,] I haven’t felt limited in any way though.”

Paul says that he’s had a full recovery and that he almost never thinks about his kidney surgery. In fact, he had forgotten the advice to avoid large doses of ibuprofen, which has been linked to kidney toxicity.

“I pulled a muscle and been taking a lot of Advil recently. I went to my doctor and he said, ‘You shouldn’t be taking that. You have a wife and two young kids now. You’ve got to be more careful.’ And wow, it finally hit home that I have to pay attention to this.”


Paul, his wife Julie, and their two daughters. Photo by Paul Brown (using timer)

David’s recovery took about a month and says he felt much better than before his surgery while he was on dialysis. However, he was not fully healthy as the immunosuppressant medication he is required to take to prevent organ rejection made him susceptible to infections. Despite it all, David says he doesn’t know what his life would have been like if Paul hadn’t offered his kidney.

Next, David has a setback and a new prognosis.

[Update: Removed quote about Paul’s serum creatinine since it is not a health factor for him. More about kidney function after a donation in an Apr 2011 blog post.]

I distinctly remember how I first learned about unrelated donor transplants. In the late 1990s I was working in Denver at Quark, Inc. when one of my coworkers offered to donate a kidney to another coworker. I didn’t even know that someone unrelated to the recipient could donate a kidney. Their mostly positive experience is a major reason why I become a nondirected donor.

The story start with David Allen, who in the fall of 1999 was a product analyst at Quark. David is a big guy, about 7-foot tall, a former pro baseball prospect who was still very athletic. He describes the events leading to his diagnosis of end-stage renal disease (ESRD).

“I first noticed a problem while playing [recreational league] baseball. I was losing my eyesight and had trouble reading pitches. It progressively got worse. One day a ground ball came to me. I missed it and turned around and I couldn’t see it. I turned my head and I could see it in my peripheral vision, but if I looked directly at it, it disappeared. I told the coach I have to take myself out of the game. I was pretty concerned at that point.

“I already had an appointment with the optometrist for the next day. He said, ‘I can work on your eyes, but I want to send you to an internist.’ They were in the office next door.”

One of the doctors checked David’s blood pressure, it was 275/175. A systolic/diastolic blood pressure between 110/65 and 130/85mm Hg is considered the optimal range. 210/120mm Hg is considered Stage 4-very severe. David’s blood pressure was significantly above that. His loss of eyesight was a side effect of high blood pressure known as hypertensive retinopathy.

“They took some blood samples and asked me if I wanted to go home or check into the ICU. At that point, I was in bad shape. I’d lost 75% of my vision. So I went in [to the hospital]. He [a nephrologist] later told me, ‘Your creatinine is 14. You have end-stage renal failure.’”

The optimal serum creatinine level for an adult male is between 0.7 and 1.2 mg/dl. (For women, the optimal range is lower, from 0.5 to 1.0 mg/dl.) A level of 10 or higher indicates kidney failure and requires immediate renal replacement therapy, either dialysis or a transplant, to avoid death. David continues,

“I saw a really badly produced video about kidney disease. They wanted to put me on dialysis then, but my blood pressure was too high. Finally, after a week of treatment, my blood pressure is still high, but they put me on emergency dialysis.”

Getting an offer of a kidney

Another of my coworkers at Quark, Paul Brown, saw how kidney disease was taking its toll on David. He recalls how he made the decision to get an HLA crossmatch test, one of the first step to becoming a donor.

“I don’t remember him [David] ever being sick. He was just fine one day and the next day we heard he’s in intensive care. Certainly after he came back to work, I noticed a change. He was dependent on dialysis. I was working closely with him on a couple of projects and he was gone three days a week for treatment. It was pretty disturbing, thinking about what his life was going to be like.

“I knew he was hoping to get a transplant. He mentioned that some of the guys on the baseball team were thinking about getting tested. So I decided to get tested too.”

David remembers the events a bit differently.

“One day as I was leaving work to go to dialysis, Paul asked me for the phone number of the center. He had just been promoted to assistant product manager and I thought he wanted the number so he could call me with questions about work. But I didn’t want him bothering me, so I said ‘no, I’ve got to leave now.’

“The next day he asked again. And I still thought he was just being pushy. So asked him what was so important that he wanted the number of the dialysis center. And he said, ‘not that number, the number for the transplant center.’ He wanted to get tested.

“I said, ‘Are you sure you want to do this? I mean, sure I want your kidney. But don’t do it if you want to be a hero. You have to realize how serious this is.’”

Paul went in and began the donor process. Like most people who volunteer to donate, he was unfamiliar with the evaluation process. He also wasn’t expecting to be accepted since David’s own brother had been tested and rejected. However, it turns out Paul was a good match for David. He was blood type compatible and HLA crossmatch compatible. In fact, out of the six major human leukocyte antigens, Paul was an identical match for two of David’s. When Paul learned he was a good match, he was surprised.


David Allen (left) and Paul Brown after their successful surgeries. Photo by Julie Brown

Every person who makes the decision whether to donate a kidney takes a slightly different path. Most people, even if they know someone with kidney disease, never think about donating. So the decision never gets made. But once confronted with the decision, there are lots of reactions. Some people make the decision instantly, based solely on their emotional ties to the recipient, without regard to the medical consequences. Others take more time, talking to friends and family before making their decision. A few spend time poring over medical research before deciding. Paul jokingly describes how he made his own decision.

“It’s kind of funny. I never made the decision to donate. I just went to get tested and figured that would be it. But then I matched and so I went to the next step. And then the next, and so on. Then I woke up and I was down one kidney.

“I never sat down and did any research on it [kidney donation]. I put my faith in the medical crew that if they say ‘yes, this is something you can do’ then they must think it’s acceptable. I never felt I couldn’t trust them.”

There was another reason that Paul knew he should continue with the donation process. Paul is tall, about 6’-2”, but is still ten inches shorter than David. Like other organs, kidney size is related to height. And ideally, a transplanted kidney’s volume should be similar to the recipient’s original kidney. This put Paul’s kidney at the lower end of the range of the ideal kidney volume for David. Says Paul,

“I remember thinking at the time that with his [kidney size] restriction, his chance of finding a suitable donor was next to zero.”

The next blog entry discusses the day of the transplant.

Ronald Lee Herrick, the world’s first organ donor died last month. Mr. Herrick donated a kidney to his twin brother Richard in 1954 when they were both 23 years old. You can read his obituary in and in the AP syndicate. His death occurred just four days after the 56th anniversary of his pioneering kidney operation (called a donor nephrectomy).

RonaldLeeHerrick Ronald Lee Herrick. Photo from AP

Prior to the Herrick brothers’ surgery, organ transplants had been performed on animal subjects but the transplants, usually skin grafts, would be rejected and the host would often die. A surgeon at what is now Brigham and Women’s Hospital in Boston named Dr. Joseph Murray speculated that transplants between identical twins would overcome that obstacle. He was correct and later went on to win a Nobel Prize.

Until the invention of immunosuppressive medications like cyclosporine, organ transplant was considered a high risk therapy, even between identical twins. Today, organ rejection is a serious but usually manageable condition and most organs for transplant come from unrelated deceased donors. Among living donors, related donors are still the most common, but unrelated donors are a rapidly growing group (see Jun 2010 blog post).

Mr. Herrick was the longest surviving organ donor the entire time he was alive. Given his young age at the time of donation, and the small number of transplants performed until the 1980s, it’s unlikely that Mr. Herrick’s longevity record will be broken any time soon.

Back in 1954 a donor nephrectomy was a very invasive procedure. It involved removing a rib and a long postoperative recovery. The risk of death from surgery was much higher then too. Plus, as the first donor, neither the surgeon or the patient would know what the long-term consequences of living with one kidney would be. So here’s to you Mr. Herrick; your bravery paved the way for all of us donors who came after you.

[Update1: I was just thinking. I’d like to live 56 years beyond my donor surgery date (9/29/2010). That would only make me 107!]

[Update2: I was wrong about how likely it is that Mr. Herrick’s longevity record will be long-standing. There are several other donors who were about the same age as him who donated to an identical twin sibling in the early 1950s. At least one of them is still alive as indicated in Boston Globe Apr 2011.]

by George Taniwaki

A video recently posted on Real American Stories focuses on the story of Sandie Andersen, a barista at a Starbucks in Tacoma, WA. One day she learns that one of her regular customers has end-stage renal disease (ESRD) and needs a kidney transplant. She immediately decides that she will donate a kidney to her. Only one problem, she doesn’t know the customer’s name! She eventually learns the name of customer is Annamarie Ausnes and they completed their transplant in 2008. The story of this donor-recipient pair was mentioned in a May 2010 blog post.


Annamarie Ausnes and Sandie Andersen. Video still from Fox News


ABC Person of the Week. Video still from ABC

A different kind of kidney transplant chain

Sandie and Annamarie’s story has inspired another donor-recipient pair. After seeing the story about Ms. Anderson’s gift of life, Laurie Sobocinski, a nurse at GroupHealth decided she would find a way to follow the same path. The very next day, a coworker mentioned that her son-in-law Ryan Campbell, a pilot for Frontier, was looking for a donor. The two matched and the transplant was completed in April 2010.

All four met earlier this year, an event shown in the video above. Three news stories about Ryan and Laurie are shown below.


Ryan Campbell and Laurie Sobocinski. Video still from Fox News


Ryan Campbell and Laurie Sobocinski. Video still from Fox News


Laurie Sobocinski gets a free makeover. Video still from Fox News

Much thanks to Rich Bloch, a kidney patient advocate and board member for the Northwest Kidney Centers Foundation, for passing on links to the first and third videos to me. And thanks to Ryan Campbell, the recipient in the second story, for providing the links to the other three videos.