Dec. 12, 2008 -- This is a story about two friends, a kidney transplant and the complications that arose along the way.
We've come to take the transplants for granted. Around 17,000 kidney transplants are performed each year.
This story was close to me because I knew both the donor and the recipient. The only person I didn't know was the one who was the inspiration behind what happened. Her name was Madeleine -- Madi, for short. She was 5 months old at the time.
The donor's name was Joan LeFosse. She assigns production staff who gather story material for "20/20," where I work.
The recipient was Ani Mozian-Whitney, a field producer who once received most of her assignments from Joan.
I can't be objective in writing this, because I've worked with them for years at ABC. I attended Joan's wedding and a birthday celebration for Ani. We've all mourned the loss of loved ones who died too young.
But there was also an unexpected element: You find out that however close you thought you were to your friends, you may not have known the most important thing about them.
One thing I never realized was how deep the friendship between Joan and Ani went. Both had gone through emotional havoc in their lives. For Joan, it was related to an overwhelming feeling of helplessness as the friend and mentor who had seen unique potential in her and helped place her at ABC -- a high school teacher named Nancy Pfifferling -- died of lung cancer.
I will never forget how devastated Joan was by the loss, and one of the people Joan turned to during that time was Ani.
"She really got me through a period when I felt like I was drowning," Joan said. "She got me above the water."
Ani first experienced chronic kidney failure in her 20s -- doctors don't know why -- and she received a kidney transplant at the age of 25.
When she married Wil Whitney in her mid-30s, one of their goals was to have a baby, despite the additional strain it might put on Ani's transplanted kidney. It was a risk her doctors agreed to and Joan understood how much Ani had invested emotionally in the prospect.
"It's probably the greatest thing she's ever wanted in her life," Joan said.
The problems arose in the third trimester of Ani's pregnancy. Her kidney function began to decline. Doctors monitored her constantly, but saw no improvement.
Dr. David Cohen, the medical director of renal transplantation at New York's Columbia University Medical Center, noticed that "all of a sudden, from her perspective, things started to fall apart. We would go week by week, and when things really started to become problematic, it was clear that if we went too much further, we would endanger the mother and the baby."
The decision was to deliver the baby seven weeks early by Caesarean section. And if there was ever a doubt that Ani is a typically obsessive news producer, that was erased the day she gave birth -- Feb. 2, 2008 -- when she said to her anesthesiologist: "Don't forget to cue my husband."
She wanted to make sure that Wil had gotten the money shots with his digital camera.
The star of that moment was the girl they would name Madeleine H. Whitney. The H stands for hope.
"We were hysterical, crying for joy," Ani said. "And the most amazing photo came out of this."
"Our doctor is holding the baby out, and Madi's just reaching up into the air," Wil said, "like she's looking up to God. And there's a light coming down right on her. Little blessed baby."
'I'm Ready to Donate My Kidney to You'
Everyone hoped that Ani's kidney function would stabilize after that; it didn't. Measures of a chemical called creatinine, which indicates how well a kidney is working, were five times what is normal.
Joan was one of the first to know that her friend, a mother for barely a month, was in failing health and needed a new transplant. The waiting period for a kidney transplant in New York is two to five years. If Ani had to go on dialysis, it would not only affect her ability to work, but also to care for Madi, the daughter she had wanted so much.
In reply to one of Ani's e-mails, Joan sent one that was uncharacteristically short. It said, "Call me."
"So then I called her," Ani said. "And she kind of started crying, and she said, 'you know, I'm ready to donate my kidney to you.'"
Joan described Ani's response. "All she said was, 'really.' In the softest voice I've ever heard. And then we cried. And we laughed."
Joan told Ani she was serious about the offer. She believed she was meant to do it.
In that offer were echoes of the devastating emotions Joan had felt when her mentor died, the feeling of helplessness when confronted with the effects of a merciless disease like lung cancer. In the case of her friend Ani, there was something Joan could do, not only to offer her friendship and support, but also to offer a part of her life to return Ani to good health.
Determining whether Joan's kidney would be a match for Ani involved a series of tests. Among other things, the tests assured that their blood types were compatible and that Ani's blood didn't have antibodies that would attack a transplanted kidney from Joan. After two weeks of waiting, the call finally came.
"Dude!" Ani said to Joan. "We're a match!"
Dr. Alan Benvenisty, director of the Kidney Transplant Program at St. Luke's-Roosevelt Hospital, had performed Ani's first transplant. Because of the long relationship they had established, he was on board immediately to perform the transplant for which Joan had volunteered as a donor, although plenty of potential obstacles remained.
"There are many points along the way where the donor can have trouble," said Benvenisty. "The kidney may be anatomically unsuited. They may turn up some antibody that could preclude the transplant. The donor could be found to have some other medical problem."
Donors can live perfectly normal lives with only one kidney. Nevertheless, the families involved had their own issues. Joan's husband, Erik Paulsen, a composer and songwriter, held back on expressing his initial concern about his wife giving up one of her organs.
"It wasn't easy for me to hear that," he said. "I think the turning point for me was I had written a song for Joan, a love song ... and this thought came to me, 'this is why I wrote this.' Because Joan came to my rescue in my life, and it makes sense that she would come to Ani's aid. And I came downstairs from the studio, and I said to Joan, 'I'm all on board.'"
Joan actually went into physical training and onto a special diet for her kidney. Even her no-nonsense Brooklyn-Italian attitude broke down on the day doctors scanned her kidney for an image of it and she got a firsthand look at the gift she had volunteered to give.
"I'm looking at a kidney," Joan said, "but it's like giving her my heart."
For a while, Joan and Ani kept Joan's offer a secret at work. When it finally leaked out, the reaction was overwhelmingly positive, although some of Joan's friends had reservations.
The three of us were on a stroll in Central Park one day when Ani asked Joan if anyone had told her she was crazy.
"Only a few people," Joan said. She said they had asked, "Have you really thought about it? Are you sure? Maybe you might think about reconsidering."
The Greatest Gift: Friends Offer Organs
Those of us who were waiting with Ani and Joan for the day of the transplant had heard what the doctors had said -- that something could still go wrong -- but it didn't really register. Not until it happened on the day of their last tests before the transplant that had been scheduled early in June 2008.
Dr. Benvenisty revealed that Ani had developed new antibodies against Joan's kidney.
"Remember, Ani had a pregnancy," he said. "And pregnancy sometimes causes a spike in antibodies. It's terrible, but our first responsibility is to the welfare of the donor, and we keep that paramount in our mind at all times."
He called off the scheduled surgery until other options could be explored.
Joan compared the feeling to what it must be like to train all year for a marathon, then have it called off. She also had to deal with sudden expressions of sympathy from people who didn't know how else to react.
"It was weird," Joan said. "People were coming to me and apologizing when they heard that [the surgery] was postponed and I might not be the donor. And quite honestly, I didn't really know what to do with that."
At that point, there was another unpredictable shift in the circumstances surrounding the story. A second potential donor entered the picture. Lorraine DeBlanche is a member of the faculty of nuclear medicine in the department of radiology at the University of Arkansas for Medical Sciences in Little Rock. Her husband was Jonathan Drummond-Webb, a transplant surgeon at the Arkansas Children's Hospital, where the couple first met Ani.
Lorraine remembered that she and Jonathan connected with Ani "on multiple levels. Because Ani had been a kidney recipient in the past, a fondness developed that, looking back now, was destined to be."
When the two became friends, Ani was on an extended assignment for an ABC News show about the children's hospital. Jonathan worked night and day as the chief surgeon at the pediatric heart unit.
The show was a success. No one could anticipate the tragedy that was coming. For reasons no one fully understands, Jonathan committed suicide during the Christmas holidays in 2004.
"I want to say that something happened at some point that night that, just in his exhaustion, he probably just felt that he could not carry on," Lorraine said. "I'm just really sorry that I did not get the time to say goodbye."
After her husband died, Lorraine returned to her native country, South Africa, with her parents.
"I needed to regroup," she said, "because my life was pretty much part of his life, and that's how it was planned. I had no Plan B."
Finally, Lorraine returned to Little Rock, to the house that she and Jonathan had shared.
"Some people would think [it] strange to go back to a place where such an event occurred," she said. "But to me it was going back to a place where we shared a space. ... And I have not regretted that decision at all."
Having stabilized her life, Lorraine learned from Ani that Ani was in need of another transplant and that her scheduled surgery with Joan had been postponed. Lorraine reacted without hesitation and volunteered one of her kidneys.
Arrangements were made for her to be tested in Arkansas. With the whole undertaking still on hold while medical issues were sorted out, it was impossible not to be struck by this new variation -- that now, two people were in this medical lottery, competing, in a way, to sacrifice an organ for a friend.
'Madi Is Hope'
Those of us watching from the sidelines were astonished and impressed by the circle of women whose lives were suddenly interrelated and uplifted in ways no one could have anticipated.
Dr. Benvenisty was happy to have Lorraine tested as a backup but he also had his own plan.
Ani was within weeks of having to go on dialysis. Her creatinine was rising. She was exhausted. With time running short, Dr. Benvenisty turned to a process he uses on only about 5 percent of his kidney transplant patients. He put Ani through plasmapheresis, a process that temporarily removed antibodies from her blood to prevent them from attacking the transplant.
Then, another cross-match was done, with results that Dr. Benvenisty had hoped for. He felt that it was safe to go ahead with surgery and the logical choice, he said, was Joan.
"We already knew that Joan was a good donor," he said. "We had a CT scan and we knew the anatomy. We knew everything about her. ... We didn't want to take a chance that we would have a problem with Ani's health before we got her transplanted."
Lorraine flew to New York to offer her support and to join Ani and Joan on the day the transplant was scheduled: June 30, 2008.
Erik and Wil, the husbands, seemed to be the most nervous members of the group that gathered, which included Ani's parents.
Joan and Lorraine had their own, private meeting before the surgery. After the two hugged each other, Joan was the first to express what was on both of their minds, referring to the loved ones they had lost and the satisfaction that came from helping assure the future of Ani and her daughter: "What Ani has given both of us may be some closure."
"It has helped me as well," Lorraine said.
She had the feeling that her husband, Jonathan, was, in a way, playing a role in the event.
"I feel as if it's gone full circle," she told me later. "Now there's life given back to Ani. So it's an incredible opportunity for me to be here, and it's a huge, huge comfort."
Shortly after 8 a.m., Joan was wheeled into surgery. In an operating room lit by the glow of long tubes illuminated by a fiber optic halogen light source for miniature cameras, surgeons prepared to remove Joan's left kidney laparoscopically, with minimal invasiveness.
At 11:16 a.m., the kidney was taken from Joan's body and passed to Dr. Benvenisty, who had begun to prepare Ani in an adjacent operating room.
Including the preparation, Ani's surgery lasted 4½ hours.
"The kidney's in," Dr. Benvenisty finally said. "It looks real good."
The defining moment was when he first saw urine pass from Ani through the kidney that had been transplanted from Joan.
"Now it's Ani's," he announced in the operating room. "She has laid claim to the kidney."
Later, he added, "I find it miraculous every time I see it."
No one can predict how long the transplant will last. Under the best circumstances, the kidney could be good for an additional 20 or 30 years. Success rates are greater if the donor is living.
For the two friends, it was something "we both went through that no one else can experience," said Ani.
Joan was back at work in a few weeks -- healthier, she says, because of all the dieting and exercise she did preparing for the transplant. Ani returned three months after her surgery, in September.
"Now," she said with a laugh, "I have the energy to wake up when Madi's screaming for the pacifier."
Madi Whitney is still happily unaware of all the changes and transitions in the lives around her leading up to her first Christmas. The big gift, she already has received. And sometime in the future, her mother and the person who gave it to her can tell her the story first hand.
It is about "life, and hope, and future," Joan said. "Madi is hope."
For more information on the doctors featured in this story, visit St. Luke's Roosevelt Hospital Transplant Center.