The gift was simply too much. The two Baltimore women weren't cousins or even best friends, just co-workers friendly in the office.
But Margie Goralski Stickles wanted to give Rhonda DeLaremore a kidney.
So yesterday morning, after clasping hands on side-by-side gurneys, the women were rolled into surgery at the University of Maryland Medical Center. Physicians removed Stickles' left kidney. By early afternoon, it was in DeLaremore and appeared to be working fine.
"I prayed for a miracle, and it was Margie," said DeLaremore.
Advances in surgery and new drugs have made it much easier for people to donate organs to nonrelatives, and nationally, the -- number of unrelated kidney donors has more than doubled, from 71 in 1994 to 153 last year. Locally, one-third of the kidney transplants at the University of Maryland Medical Center are from living, unrelated donors, up from a rare few just five years ago.
Studies have shown that, as with Stickles, most are motivated by altruism.
Stickles and DeLaremore work for the Transplant Resource Center, a nonprofit organization that procures donated organs and tissues for Marylanders. Stickles is 35 and married, with a 14-year-old son and a 2-year-old daughter. She's a registered nurse who coordinates organ donations.
DeLaremore, 41, was diagnosed with pyelonephritis, a kidney infection, when she was 32. Within a few years, it led to renal failure. She was put on dialysis and grew too sick to work or keep her own apartment. But in 1993, her sister gave her a kidney, and she was well again, so well and appreciative of her second chance that she adopted a baby girl, Anya, and vowed to raise her.
She also took a job educating the public about organ donations.
But this spring, scar tissue caused the kidney to fail. DeLaremore explained to her colleagues why she was sick. Stickles was standing nearby. Independently, each woman had a powerful feeling: DeLaremore that somehow she was going to be all right; Stickles, that she should give her kidney to DeLaremore.
"I just was overwhelmed by the thought of her being sick, taking care of her baby," Stickles said.
A common bond
Even though the pair didn't socialize and rarely worked closely together, Stickles felt a bond with DeLaremore. Stickles, too, had been a single mother, and her daughter had battled the same kidney infection. Even more, Stickles respected DeLaremore's faith, graciousness and humor. Quietly, she went about being tested and talking to her family.
Medical tests showed that key proteins of both women matched in four of six cases.
"We are all a lot more alike underneath than some of us want to believe," said DeLaremore, who is black. Stickles is white. She said they'd matched better than she did with her own sister.
But there were still sticky emotional issues.
"This isn't like lending somebody $5. How do you really thank somebody for giving you a part of their body when they don't have to do it?" DeLaremore asked. "I felt like, how will our relationship change? Am I going to have to be beholden to her for the rest of my life? Every time I see her, say, 'Thank you, thank you, thank you?'"
As director of consultation psychiatry at the University of Maryland Medical System, Dr. Mark Ehrenreich has plumbed these emotions. He has evaluated many unrelated donors before transplants to ensure that there is no subtle coercion and that the patient knows that removal is a serious operation, with risks -- mostly bleeding.
Maryland surgeons have performed transplants in cases in which a parishioner has donated to a minister, and a second wife has donated to a first wife, said Dr. Stephen Bartlett, professor of surgery and head of the University of Maryland Medical Center's division of transplantation. Doctors there have performed 285 laparoscopic kidney transplants, more than any center in the world, he said.
Recently in Washington, a worker donated a kidney to her boss. Prospective donors have contacted the United Network for Organ Sharing, the nonprofit organization that maintains the national transplant waiting list, saying they want to donate.
Studies show that in most cases, people who donate organs to someone they're not related to are doing it to help someone, and it becomes a defining moment for them, Ehrenreich said.
Stickles felt confident from the outset. She knew the risks, and even though DeLaremore kept giving her chances to back out, she kept moving forward, test after test. The momentum grew. Soon, the women were hugging one another every time they met.
"If it buys her a few more years without having to tolerate dialysis, whatever it takes," Stickles said. "I have the ability to help. I'm just able to do it, and I want to."
Some 40,000 people nationwide are on the waiting list for kidney transplants, and about 11,400 transplants, including 3,700 from living donors, were performed last year.
More unrelated donors
Doctors say it might be better to have an unrelated donor, because hypertension and diabetes, two of the main causes of kidney failure, often run in families, making it difficult for members to donate the spare organ they may need themselves.
Medical advances also are driving this trend.
Among them is the less invasive surgery pioneered in 1995 by Dr. Lloyd Ratner and Dr. Louis Kavoussi at Johns Hopkins Hospital. Surgeons make small incisions and insert a fiber-optic camera and other devices so they can perform surgery without the larger incision -- and removal of part of a rib -- that used to be required.
With this laparoscopic technique, doctors put the kidney in a plastic bag inside the abdomen, then pull it out through a 2-inch incision. Recovery time can be reduced by as much as half. A small but growing number of surgeons worldwide now use this procedure, and many places are reporting increases by as much as double in the number of living donors, Ratner said. About 20 percent of donors say they wouldn't have given a kidney if they had had to undergo the old-style surgery.
Four new drugs, including two that can be used long term to fight organ rejection, also are making a difference, Bartlett said. Donors should be able to lead a healthy, normal life.
A successful operation
Last night, a spokesman at the University of Maryland Medical Center reported that Stickles and DeLaremore were in "terrific shape."
Meanwhile, the women have solved the issue of how DeLaremore can repay Stickles.
"I told her to raise her daughter and promise that our daughters will always be friends," Stickles said.
Though the girls, 2 and 3, haven't yet met, their mothers hope to get the families together for dinner soon.
For more information or free donor cards, call 1-800-641-HERO.
Pub Date: 12/17/98