Robyn Brandon remembers July 2004 as a month of firsts -- she bought her first house, took her first trip to Disney World with her husband and four kids and, at the end of the trip, she had her first kidney failure.
Within three weeks her kidneys completely gave out, a result of a rare disease, and she was put on dialysis, hooked up to a blood-cleansing machine three times a week.
"I don't want to die like this, on this machine," Robyn remembers telling her nurses. She had lost weight, became depressed, and had come close to death when she contracted a virus. Robyn's doctors hoped to get her a kidney transplant but realized that finding a suitable match for her particular blood and tissue type would be rare.
"I had hope I could live a normal life but when my doctor said that, I went home and cried," she said.
Her husband Alan wouldn't give up on her. As he described it, he watched his own mother, who passed away years earlier, get the "life sucked out of her" enduring dialysis treatments. The Brandons, who have been married for 19 years, would end up making another first -- taking part in a kidney exchange that would involve two other couples, two hospitals, and a cross-country journey of Robyn's new kidney.
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More than 74,000 Americans are waiting for kidney transplants, according to the National Kidney Foundation, and the list continues to grow every year. Only about one-fourth will get one this year. The rest will either die waiting -- on average 12 people a day -- or become too sick for a transplant.
The shortage is so severe that some are taking things into their own hands. Four years ago, "kidney wanted" ads started appearing on Matchingdonors.com, a Web site created by a doctor and his patient, where people can browse profiles created by those in need of kidneys.
The Web site is a nonprofit venture whose stated mission is to augment "the current failing system" and enable those who are sick to find "potential altruistic live organ donors" over the Web. More than 5,000 potential donors have already registered.
But some people have raised questions about the fairness of the site. There are various fees to make a wanted ad (it's $595 for a lifetime membership, although the site now offers a more affordable $25-a-month plan).
Samuel Kerstein, a philosopher and fellow at Harvard's Program in Ethics and Health, points out that "it is uncomfortable to think of people in need of organs having to make some kind of case for themselves" and ponders how one chooses one case over another.
"Why should someone who is a more moving writer be more privileged in getting an organ than someone who is less eloquent?" Kerstein asked. Although he thinks for the most part the site is a good idea, as long as donors are well-informed and receiving no payment, which would be illegal.
Another way to increase donor transplants is to increase kidney exchanges, which Dr. Robert Montgomery, the chief of transplantation at Johns Hopkins Hospital and Robyn Brandon's surgeon, has helped pioneer.
In early 2007, Montgomery found the rare match for Robyn in Tomomi Barron, a healthy woman living in California. Tomomi's husband, Patrick, was one of those who turned to the Web seeking a donor after his kidneys failed. But they had also reached out to Hopkins, as well as to other hospitals close to them, and were able to get matched.