To see 2-year-old James Paglio of Fort Meade playing on the floor, his cherry-red cheeks glowing as he tows a toy truck behind a sofa, you'd never know that he suffers from kidney disease so severe he often needs up to 15 medications a day and has been on dialysis since October. His warm, crinkling eyes belie how he once feared strangers — all too many have come to perform painful medical procedures.

To see 19-year-old Taylor Chappell of Glen Burnie, you'd never know that doctors have deemed her an ideal donor match for James, though the two are not related. She intends to give him a kidney over the weekend — one that James' parents hope will last him into adulthood.

What began as an effort by parents in several close-knit Anne Arundel County communities to find a kidney match for James has resulted in a donor among them coming forth.

"I'd seen James in the neighborhood, but I didn't know anything about him. I heard other moms in the neighborhood were getting tested to see if they were compatible," said Chappell, a waitress at Founders Tavern & Grille in Pasadena, who said the surgery will be her second-ever procedure. She said she had an operation for appendicitis last year.

"I didn't even know my blood type," Chappell said. "I said, 'I will go and do the first round of testing.' I came back fine and went to do a little more. They kept sending me test kits and there were no issues, and that's how it happened."

For James' mother, Helen Paglio, Chappell's generosity culminates a tireless donor search for her son, who was diagnosed with structural urological anomalies while she was pregnant with him. James, she said, suffers from vesicoureteral reflux, backward flow of urine from the kidneys.

"Unfortunately, that occurred while he was still developing his kidneys, and the damage done is irreversible," said Paglio, who said James' kidney abnormalities were discovered during her ultrasound at 20 weeks.

"They were underdeveloped and abnormally developed," said Paglio. "At the first discharge from the hospital stay, we knew he would need dialysis and a transplant. Children with kidney failure have many more complications even than adults do, because there is so much growth that takes place."

And as James grew older, Paglio said, complications multiplied. When he didn't eat and drink, a feeding tube was inserted in his stomach. He suffered high output renal failure, a condition in which large volumes of urine drain without being concentrated properly, denying the body necessary nutrients.

When James' stomach stopped working, he required a tube inserted into his intestine, said Paglio, who added that often liquids that sit in his stomach get discharged through vomiting. Before being prescribed medication that has somewhat alleviated the problem, Paglio said, James would vomit more than a dozen times a day.

"At one point we were in the hospital getting lab work every six hours," said Paglio, "and he was having blood drawn three times a week so he could be medicated. Used to just scream and throw things at people who come into the room. He just knows when people come to him, they're going to do something to him and it's going to hurt. 'No' was his first word."

James gravitates, however, to the woman scheduled to give him a kidney during a surgery on Sunday. Chappell said her biggest concern has been her life immediately after the procedure. Recovery is expected to take up to six weeks, and she is worried about lost wages while away from work.

In stepped Pasadena resident Kristi Stein, an elementary school teacher who works part time as a waitress at the restaurant. On March 13, she launched a fundraiser for Chappell on the Chicago-based fundraising website Give Forward. She set a target of $10,000 to be raised until May 15. As of Wednesday, the site had received $5,205 via 47 donations.

"Her need to save money for this, to work shifts, to work double-shifts, and to watch her do this and do that was unbelievable," said Stein. "I went to Founders and I said, 'Why can't we raise money for her to not have to worry about all this?' We all are working together to doing this, and it's been awesome."

Chappell called Paglio on March 13 to say she was going through with the procedure — coincidentally, March 13 was World Kidney Day, an initiative launched by the International Society of Nephrology and the International Federation of Kidney Foundations to raise awareness of kidney health and reduce kidney disease.

Living donors usually range between 18 to 60 years of age and are often close relatives of the recipient, according to the Denver-based American Transplant Foundation, a private nonprofit organization that seeks to reduce the recipient waiting list by providing information and grant funding to potential living donors. The foundation said that there are more than 6,000 living donations per year, and the kidney is most common living organ donated.

Paglio, a mother of six, said James has been on the donor list for more than a year locally.

Chappell's donated kidney will be transplanted into James, Paglio said, and his two kidneys will remain in place to buffer hers.

Later in life, she said, James will need another kidney transplant. For now, she said, she's focused on the donation he is slated to receive within a few days.

"She's such a better prognosis than a deceased donor. The rate of rejection" is lower, Paglio said. "And to get a kidney donation from a young donor is optimal because kidneys age as we get older. He's really getting the best shot possible."

Chappell said that since making her decision to donate she has had no second thoughts and that getting to know James crystallized her resolve.

"I will talk with people about it, and they say, 'You're 19. What are you doing?'" she said. "I don't get it. If you have the ability to do it, why wouldn't someone do it?"

jburris@baltsun.com