Linda McGrain calls herself a wimp when it comes to blood.
But when she learned last fall that her brother-in-law, Frank Meeder, needed a kidney transplant, she volunteered with a handful of others to be tested as a donor.
McGrain turned out to be the closest match -- and 51-year-old Meeder's best shot at a healthy future.
"I'm scared to death, don't get me wrong," says McGrain, 48, days before the January surgery. "But I know in my heart this is what I need to do."
Every day, 17 people die nationwide waiting for an organ transplant. But McGrain joins a growing number of Americans stepping forward as living organ donors to ease the crisis. In fact, 2001 marked the first time that there were more living donors than deceased donors nationwide.
And that trend is expected to accelerate, medical experts say. In 1988, living people made up 30 percent of all donors. By 2001, that figure had risen to 52 percent.
Yet living donation raises an ethical quandary for the medical community. Doctors know organs from living donors offer the best hope for patients. But they are ethically prohibited from encouraging anyone to donate because of the surgery risks associated with donation.
"Ethically, we don't want to be seen as bullying people into becoming donors," says Dr. Benjamin Philosophe, acting director of the University of Maryland Medical Center's Division of Transplantation.
McGrain's decision to become a living donor didn't have anything to do with being bullied. It was all about love.
Her brother-in-law, Meeder, 6-foot-4 and athletic, had been battling polycystic kidney disease for decades. Doctors told the Cockeysville resident his kidneys would one day shut down.
Last summer, on the tennis court, friends could tell something was wrong with him. Meeder's wife, Kathleen, couldn't bear to watch him play, fearful that he'd collapse as his health declined.
By October, University of Maryland Medical Center doctors gave Meeder grim news: He'd soon be headed for dialysis to remove toxins from his blood because his kidneys weren't doing the job.
Meeder, a financial analyst, was advised to put his name on the national waiting list for organs -- a list of nearly 84,000 people nationwide awaiting hearts, lungs, pancreases, intestinal organs, kidneys and livers from deceased individuals.
More than 56,000 people already were waiting for kidneys, and 1,500 of them live in Maryland. "I'd be looking at a wait of at least four to five years, if ever," Meeder says.
To complicate matters, he needed both kidneys removed before a transplant was possible. Doctors guided the family through their options, which included sending out questionnaires to see if family or friends would donate a kidney.
Meeder's family wasn't an option for donation. Two of his three younger brothers suffer from the same disease and likely will face transplants themselves. Meeder's mother died in 1980 trying to receive a kidney transplant from a deceased donor. She had been on dialysis for years, and her body was worn down.
"She never got through the surgery," Meeder says.
Still, there was hope. Scientific studies show that kidneys from unrelated donors, such as spouses and friends, succeed as well as those from siblings who generally are closer tissue matches.
Kathleen Meeder comes from a large family with eight siblings and a network of relatives throughout the state. She quietly began inquiries along with making plans to be tested.
"I started e-mailing out the information," she says. "And a few people said, "No, just can't do that ... which I totally understand."
Her older sister, Linda McGrain, quiet and not one to jump to rash decisions, responded immediately. The family was surprised. McGrain, who is single and lives in Towson, likes helping others, but donating a kidney was a different matter. And then there was the blood.
"Even Linda will tell you she can't stand the sight of blood," says older brother Bob McGrain.
But McGrain persisted. "She is one of the most generous people I know," says Sister Natalie DeLuca, of the Mission Helpers of the Sacred Heart, where McGrain volunteers. "Her decision is a mammoth example of who she is every day."
McGrain says she was taking her cues from above. "This is coming from the Lord Almighty, because I never would have thought I'd be in this position."
The weekend before the surgery, McGrain got together with Frank and Kathleen and their two children, Mollie, 13, and Andrew, 11. To her, donating while alive made sense: "I'm an organ donor on my license. But I thought, if I can see the benefits while I'm on this Earth, that's an incredible blessing," she says.
Doctors say the risk for a kidney donor is small, with a mortality rate at about .03 percent. Other organ donations are trickier. Mount Sinai Hospital in New York just resumed live-donor liver transplants after a two-year hiatus, after the death of a 57-year-old man who gave part of his liver to his brother.
Eugene J. Schweitzer, University of Maryland's director of kidney transplantation and one of Meeder's surgeons, says there is no way around the risks for donors: "You're dealing with a healthy person who is undergoing a major operation for no need. The only benefit they get is spiritual or psychological. So we don't want to do any harm."
On the morning of the surgery, about 15 relatives crowded into the hospital waiting room. Meeder was the first to be taken into surgery. When it was McGrain's turn, she hugged her sister. "I told her, 'Kathleen, everything is going to be OK.' "
With that, a team of three surgeons -- Schweitzer, Dr. Geoffrey N. Sklar and Dr. Michael W. Phelan -- worked eight hours to complete the procedure. It was more difficult than many transplants because the doctors first had to remove Meeder's diseased kidneys -- each the size of a football. Then they transplanted McGrain's healthy, fist-sized kidney, which began working immediately.
When the operations were completed, a groggy McGrain reportedly told siblings: "Tell Frank I'm never doing that again."
Less than a week after surgery, McGrain was getting back on her feet. "We've all come through with flying colors," she says. "And it's just been the most amazing process. This is what we were all praying for."
At the hospital, a relieved Meeder was preparing to go home. His recovery will be arduous, but the long-term prognosis is excellent. Doctors say kidneys from live donors can function for decades, lasting on average 17 years, compared with 11 years for cadaver kidneys.
A thoughtful man, Meeder reflected on his sister-in-law's love and generosity. "Without someone like Linda stepping forward, I was headed for dialysis," he says. "And I know I'm really the exception. I'm not the norm. If more people would step forward like Linda, then we'd have fewer people dying."
That point was not lost on Meeder's daughter Mollie. The night after the operation, she slipped a letter into her Aunt Linda's overnight bag. In part, it read: "I can't tell you how many times I feel so grateful to have you not only as an aunt, but as an angel. ... I think it's cool that when you look over your life after the surgery you can say, 'I gave new life to someone.' "
Steps for donors
If you'd like to donate your organs after you die, here's what you should do:
* Check the organ donor box when you receive or renew your Maryland driver's license. For details, visit the Motor Vehicle Administration Web site, www.mva.state.md.us.
* Or contact the Transplant Resource Center of Maryland (800-641-4376; www.mdtransplant.org) to complete a donor registration card.
* Tell family members about your intentions. Usually, the decision about whether to take organs is left to immediate family members.
* www.transweb.org: Clearinghouse for transplantation and donation information.
* www.unos.org: The nonprofit organization established by Congress that operates the nation's organ transplant network.
* www.hopkinsmedicine.org / transplant: Johns Hopkins Comprehensive Transplant Center.
* www.umm.edu / transplant: University of Maryland Division of Transplantation.
* www.lifesharers.com: A network that offers preferred access to members.
* www.matchingdonors.com: A company charging individuals to advertise for organs.